Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA.
Br J Surg. 2011 Mar;98(3):431-5. doi: 10.1002/bjs.7345. Epub 2010 Nov 25.
The role of minimally invasive surgery in complicated diverticulitis is still being elucidated. The aim of this study was to compare short-term outcomes in patients undergoing minimally invasive surgery for complicated or uncomplicated diverticular disease.
All patients who had elective minimally invasive surgery for diverticulitis between 2003 and 2008 were identified from a prospectively maintained database. Complicated disease was defined as diverticulitis associated with abscess, fistula, stricture or bleeding. Univariable analysis was performed to compare safety and short-term outcomes in patients with complicated and uncomplicated diverticulitis.
A total of 361 patients (136 with complicated and 225 with uncomplicated diverticulitis) were operated on with either a laparoscopic (36·0 per cent) or a hand-assisted laparoscopic (64·0 per cent) surgical technique. There were no significant differences between the groups with respect to age, sex, body mass index, laparoscopic approach, postoperative recovery protocol or previous open surgery. Conversion rates were similar for complicated and uncomplicated disease (14·0 versus 11·6 per cent respectively; P = 0·514). There was no difference between the groups with respect to return of bowel function (mean 3·1 versus 3·2 days respectively; P = 0·156), morbidity (27·9 versus 19·6 per cent; P = 0·070) or mean length of stay (5·4 versus 4·8 days; P = 0·186). There were no deaths within 30 days.
Elective minimally invasive colectomy is feasible for patients with uncomplicated and complicated diverticulitis, with equivalent outcomes.
微创外科在复杂性憩室炎中的作用仍在阐明之中。本研究旨在比较微创治疗复杂性和非复杂性憩室疾病患者的短期疗效。
从一个前瞻性维护的数据库中确定了 2003 年至 2008 年间接受微创憩室炎手术的所有患者。复杂疾病定义为与脓肿、瘘管、狭窄或出血相关的憩室炎。采用单变量分析比较复杂性和非复杂性憩室炎患者的安全性和短期疗效。
共有 361 例患者（136 例复杂性憩室炎，225 例非复杂性憩室炎）接受了腹腔镜（36.0%）或手助腹腔镜（64.0%）手术治疗。两组在年龄、性别、体重指数、腹腔镜入路、术后恢复方案或既往开放性手术方面无显著差异。复杂性和非复杂性疾病的转换率相似（分别为 14.0%和 11.6%；P=0.514）。两组在肠道功能恢复方面无差异（平均 3.1 天与 3.2 天；P=0.156），发病率（分别为 27.9%和 19.6%；P=0.070）或平均住院时间（分别为 5.4 天和 4.8 天；P=0.186）也无差异。术后 30 天内无死亡。
对于复杂性和非复杂性憩室炎患者，选择性微创结肠切除术是可行的，疗效相当。
