Moreaux J, Vons C
Centre Médico-Chirurgical, Porte de Choisy, Paris, France.
Br J Surg. 1990 Sep;77(9):1036-8. doi: 10.1002/bjs.1800770927.
From 1966 to 1987, 177 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were: colovesical fistula (n = 12), suspicion of residual abscess (n = 39), two or more previous attacks of acute inflammation (n = 52), chronic symptoms (n = 72) and suspicion of carcinoma (n = 2). An abscess was found at operation in 76 patients (43 per cent) and this was extracolic with local peritonitis in 52 patients (29 per cent). An unsuspected abscess was found in 25 of the 72 patients operated on for chronic symptoms. Colonic resection with primary anastomosis was performed in 95 per cent of the 177 patients and in 94 per cent of those 52 patients with an extracolic abscess. There were no postoperative deaths and no clinical anastomotic leakages. Long-term results were very good in 85 per cent of the 177 patients and in 82 per cent of the 72 patients operated on for chronic symptoms. The results of this series suggest that a one-stage procedure can be safely performed with some technical precautions in most patients operated on electively for diverticular disease, even if an extracolic abscess is found. The good long-term results in patients operated on for chronic symptoms suggest that such symptoms should be taken into account with respect to surgical indications.
1966年至1987年期间，177例连续性患者因乙状结肠憩室病接受了择期手术。手术指征为：结肠膀胱瘘（12例）、怀疑有残留脓肿（39例）、既往有两次或更多次急性炎症发作（52例）、慢性症状（72例）以及怀疑有癌（2例）。手术中发现76例患者（43%）有脓肿，其中52例患者（29%）的脓肿位于结肠外并伴有局限性腹膜炎。在因慢性症状接受手术的72例患者中，有25例发现了意外脓肿。177例患者中有95%以及52例有结肠外脓肿的患者中有94%进行了结肠切除并一期吻合。无术后死亡病例，也无临床吻合口漏。177例患者中有85%以及因慢性症状接受手术的72例患者中有82%的长期效果非常好。本系列研究结果表明，对于大多数因憩室病接受择期手术的患者，即使发现结肠外脓肿，采取一些技术预防措施后也可安全地进行一期手术。因慢性症状接受手术患者的良好长期效果表明，在手术指征方面应考虑这些症状。
