Department of Surgery, New York Hospital Queens, 56-45 Main Street, Flushing, NY 11355, USA.
Surg Endosc. 2012 Jul;26(7):1837-42. doi: 10.1007/s00464-011-2142-y. Epub 2012 Jan 19.
The benefits of laparoscopic (LC) versus open (OC) colectomy for symptomatic colonic diverticulosis as an elective operation remain unclear.
Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) participant-user file, patients were identified who underwent elective colon resection for symptomatic colonic diverticulosis, between 2005 and 2008. Demographic, clinical, intraoperative variables, and 30-day morbidity and mortality were collected. Logistic regression analysis was performed to determine the association between the surgical approach (LC vs. OC) and risk-adjusted overall mortality, overall morbidity, serious morbidity, and wound complications.
A total of 7,629 patients were identified who underwent colon resection for symptomatic diverticulosis. They were subdivided into two groups: OC (3,870 (50.7%)) and LC (3,759 (49.3%)). Patients who underwent OC were significantly older (59.0 vs. 55.7 years, P < 0.0001) with more comorbidities compared with those who underwent LC. After risk-adjusted analysis, it was noted that the patients treated with LC were significantly less likely to experience overall morbidity (11.9% vs. 23.2%), serious morbidity (4.6% vs. 10.9%), and wound complications (9.1% vs. 17.5%), but not mortality (0.3% vs. 0.8%). Operative duration was significantly longer with LC (176.64 vs. 166.70 min, P < 0.0001), but the length of stay was significantly shorter (4.77 vs. 7.68 days, P < 0.0001). Using logistic regression analysis, patients with history of peripheral vascular disease, percutaneous coronary interventions, current steroid use, and hypertension requiring medication were at an increased risk of morbidity and mortality at 30 days. Patients with history of chronic obstructive pulmonary disease and smoking experienced more wound complications at 30 days.
In the elective setting for symptomatic diverticulosis, LC seems to be associated with lower 30-day morbidity and complication rates compared with OC.
腹腔镜（LC）与开腹（OC）结肠切除术治疗症状性结肠憩室病作为择期手术的益处仍不清楚。
使用美国外科医师学会-国家外科质量改进计划（ACS-NSQIP）参与者-用户文件，确定了 2005 年至 2008 年间因症状性结肠憩室病接受择期结肠切除术的患者。收集了人口统计学、临床、术中变量以及 30 天发病率和死亡率。进行逻辑回归分析，以确定手术方法（LC 与 OC）与风险调整后总体死亡率、总体发病率、严重发病率和伤口并发症之间的关联。
共确定了 7629 例因症状性憩室病而行结肠切除术的患者。他们被分为两组：OC（3870 例[50.7%]）和 LC（3759 例[49.3%]）。接受 OC 的患者明显比接受 LC 的患者年龄更大（59.0 岁 vs. 55.7 岁，P < 0.0001），且合并症更多。经过风险调整分析，发现接受 LC 治疗的患者发生总体发病率（11.9% vs. 23.2%）、严重发病率（4.6% vs. 10.9%）和伤口并发症（9.1% vs. 17.5%）的可能性显著降低，但死亡率（0.3% vs. 0.8%）没有差异。LC 的手术时间明显较长（176.64 分钟 vs. 166.70 分钟，P < 0.0001），但住院时间明显较短（4.77 天 vs. 7.68 天，P < 0.0001）。使用逻辑回归分析，有外周血管疾病、经皮冠状动脉介入治疗、当前类固醇使用和需要药物治疗的高血压病史的患者在 30 天内发生发病率和死亡率增加的风险增加。有慢性阻塞性肺疾病和吸烟史的患者在 30 天内发生伤口并发症的风险更高。
在症状性憩室病的择期治疗中，LC 似乎与较低的 30 天发病率和并发症发生率相关，与 OC 相比。
