急症腹腔镜切除术治疗急性憩室炎的应用及效果。

Use and outcomes of emergent laparoscopic resection for acute diverticulitis.

机构信息

Department of Surgery, Oregon Health & Science University, Mail Code L223, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.

出版信息

Am J Surg. 2012 May;203(5):639-643. doi: 10.1016/j.amjsurg.2012.01.004. Epub 2012 Mar 22.

DOI:10.1016/j.amjsurg.2012.01.004

PMID:22444830

Abstract

BACKGROUND

The use and outcomes of laparoscopic sigmoid resection during emergency admissions for diverticulitis are unknown.

METHODS

The Nationwide Inpatient Sample was queried for colorectal resections performed for diverticulitis during emergent hospital admissions (2003-2007). Univariate and multivariate analyses including patient, hospital, and outcome variables were performed.

RESULTS

A national estimate of 67,645 resections (4% laparoscopic) was evaluated. The rate of conversion to open operation was 55%. Ostomies were created in 66% of patients, 67% open and 41% laparoscopic. Laparoscopy was not a predictor of mortality (odds ratio [OR] =.70; confidence interval [CI], .32-1.53). Laparoscopy predicted routine discharge (OR = 1.31; CI, 1.06-1.63) and a decreased length of stay (absolute days = -.78; CI, -1.19 to -.37). There was no difference in the cost of hospitalization between the 2 groups (P = .45).

CONCLUSIONS

In acute diverticulitis, urgent laparoscopic resection decreases the length of stay. However, it is associated with a high conversion rate, no cost savings, and no difference in mortality.

摘要

背景

在因憩室炎而紧急住院期间，腹腔镜乙状结肠切除术的使用情况和结果尚不清楚。

方法

在全国住院患者样本中查询了因憩室炎在紧急住院期间进行的结直肠切除术（2003-2007 年）。进行了包括患者、医院和结局变量在内的单变量和多变量分析。

结果

评估了全国范围内 67645 例手术（4%为腹腔镜）的估计值。转为开放性手术的比例为 55%。造口术在 66%的患者中进行，其中 67%为开放性，41%为腹腔镜。腹腔镜不是死亡率的预测因素（比值比 [OR] =.70；置信区间 [CI]，.32-1.53）。腹腔镜预测常规出院（OR = 1.31；CI，1.06-1.63）和缩短住院时间（绝对天数 = -.78；CI，-1.19 至 -.37）。两组的住院费用无差异（P =.45）。