Howard University College of Medicine, Washington, DC, USA.
J Am Coll Surg. 2013 Apr;216(4):782-8; discussion 788-90. doi: 10.1016/j.jamcollsurg.2013.02.003.
Laparoscopy has become a commonly used method of performing colectomies, but the outcomes associated with laparoscopy in the emergency setting have not been well studied.
The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients with diverticulitis without hemorrhage who underwent a colectomy. Patient data retrieved included demographics and preoperative comorbidities. Each member of the cohort received either a primary anastomosis (PA) or a colostomy. Open and laparoscopic procedures were compared within these subgroups. Multivariate logistic regression analyses were performed to compare the risk-adjusted odds of postoperative morbidity and mortality for laparoscopic and open procedures. The risk-adjusted impact of preoperative comorbidities was also assessed.
A total of 11,981 patients in the database met the study criteria. The majority were female (53%) and Caucasian (82%), and the mean age was 58 (±13) years. Comorbidities of the cardiovascular, pulmonary, or renal systems were present in 47%, 5%, and 1% of the cohort, respectively. On bivariate analysis, patients undergoing laparoscopy experienced lower rates of complications with both PA (14% vs 26%, p < 0.001) and colostomy (30% vs 37%, p = 0.02). The laparoscopic approach was associated with decreased mortality rates for patients undergoing PA (0.24% vs 0.79%, p < 0.001). Multivariate analysis revealed that preoperative cardiovascular and pulmonary comorbidities were each associated with increased postoperative morbidity, and that the laparoscopic approach was associated with lower postoperative morbidity for patients undergoing PA. The reduced risk of death for patients undergoing laparoscopic PA (vs open approach) did not achieve statistical significance (odds ratio 0.68, p = 0.3). A small number of patients underwent laparoscopic colostomy (n = 237, 2.4%), and they did not have a significantly different risk of death.
The laparoscopic approach is associated with lower complication rates compared with the open approach for the surgical treatment of diverticulitis with a primary anastomosis.
腹腔镜已成为结直肠切除术的常用方法，但在紧急情况下腹腔镜的结果尚未得到很好的研究。
美国外科医师学院-国家外科质量改进计划（ACS-NSQIP）数据库对无出血性憩室炎患者进行了检索，这些患者接受了结肠切除术。检索的患者数据包括人口统计学和术前合并症。队列中的每位成员都接受了一期吻合术（PA）或结肠造口术。在这些亚组中比较了开放和腹腔镜手术。进行了多变量逻辑回归分析，以比较腹腔镜和开放手术术后发病率和死亡率的风险调整优势比。还评估了术前合并症的风险调整影响。
数据库中共有 11981 名符合研究标准的患者。大多数患者为女性（53％）和白种人（82％），平均年龄为 58（±13）岁。心血管，肺部或肾脏系统的合并症分别存在于队列的 47％，5％和 1％中。在单变量分析中，接受腹腔镜手术的患者PA（14％比 26％，p <0.001）和结肠造口术（30％比 37％，p = 0.02）的并发症发生率较低。对于接受 PA 的患者，腹腔镜方法与死亡率降低相关（0.24％比 0.79％，p <0.001）。多变量分析显示，术前心血管和肺部合并症均与术后发病率增加相关，而对于接受 PA 的患者，腹腔镜方法与术后发病率降低相关。接受腹腔镜 PA 的患者死亡风险降低（与开放方法相比）未达到统计学意义（优势比 0.68，p = 0.3）。一小部分患者（n = 237，2.4％）接受了腹腔镜结肠造口术，他们的死亡率没有显着差异。
与开放方法相比，腹腔镜方法与接受一期吻合术的憩室炎手术治疗的并发症发生率较低。
