Minimally Invasive Surgery Research Group, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Surg Endosc. 2010 Sep;24(9):2273-80. doi: 10.1007/s00464-010-0951-z. Epub 2010 Feb 26.
Surgery is increasingly reserved for complicated diverticulitis. The role of laparoscopy in this context is ill defined. This study aimed to evaluate the safety, feasibility, and outcomes associated with the application of laparoscopy to an unrestricted spectrum of diverticular pathologies, with an emphasis on complicated disease.
Consecutive patients who underwent elective, urgent, or emergent laparoscopic colectomy for diverticular disease from 1991 to 2007 were analyzed from a prospectively collected database. Laparoscopy was offered to all patients presenting for surgical attention, thus minimizing selection bias. Complicated cases had abscesses, perforations, fistulas, or strictures. Uncomplicated cases had chronic or recurrent diverticulitis. Summary statistics and univariate comparisons were generated.
A total of 183 patients were analyzed, including 39 complicated cases. The complicated cohort included 12 abscesses or perforations (31%), 18 fistulas (46%), and 11 strictures (28%). Intraoperative complications were comparable between the two groups (7.7 vs. 9.7%), although the complicated cases resulted in more conversions (23 vs. 4.2%; p = 0.0007). More than 79% of the complicated patients and 96% of the uncomplicated patients underwent unprotected primary anastomosis. Medical (23 vs. 1.4%; p < 0.0001) and surgical (28 vs. 14%; p = 0.035) complications were more frequent in the complicated group. Leak rates were acceptably low (6.5 vs. 2.2%; p = 0.23). There were no recorded deaths. Finally, the time until discharge from hospital was significantly longer in the complicated group by a median of 1 day.
The laparoscopic management of complicated diverticular disease is feasible and appears to be safe in the hands of experts. Despite a high rate of conversion to open surgery, laparoscopy was the sole operative intervention for the majority of patients with complicated diverticular disease. Further studies are needed to allow rigorous comparison with an open control group.
手术越来越多地被保留用于复杂的憩室炎。腹腔镜在这种情况下的作用尚未明确。本研究旨在评估在不受限制的憩室病变范围内应用腹腔镜的安全性、可行性和结果，重点是复杂疾病。
从 1991 年至 2007 年期间前瞻性收集的数据库中分析了因憩室疾病接受择期、紧急或急诊腹腔镜结肠切除术的连续患者。向所有接受手术治疗的患者提供腹腔镜，从而最大限度地减少选择偏倚。复杂病例有脓肿、穿孔、瘘管或狭窄。简单病例有慢性或复发性憩室炎。生成了汇总统计数据和单变量比较。
共分析了 183 例患者，其中 39 例为复杂病例。复杂组包括 12 例脓肿或穿孔（31%）、18 例瘘管（46%）和 11 例狭窄（28%）。两组之间的术中并发症相当（7.7%比 9.7%），尽管复杂病例的转化率更高（23%比 4.2%；p = 0.0007）。超过 79%的复杂患者和 96%的简单患者接受了无保护的一期吻合术。复杂组的医疗（23%比 1.4%；p < 0.0001）和手术（28%比 14%；p = 0.035）并发症更频繁。漏率可接受低（6.5%比 2.2%；p = 0.23）。无记录死亡。最后，复杂组的住院时间中位数延长了 1 天。
在专家手中，腹腔镜治疗复杂憩室炎是可行的，似乎是安全的。尽管转换为开放手术的比例很高，但腹腔镜是大多数复杂憩室炎患者的唯一手术干预措施。需要进一步的研究以允许与开放对照组进行严格比较。
