Marney Lucy A, Ho Yik-Hong
1 Institute of Surgery, The Townsville Hospital, Townsville, Australia.
Int Surg. 2013 Apr-Jun;98(2):101-9. doi: 10.9738/INTSURG-D-13-00024.1.
Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P = 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.
继发于憩室病的结肠膀胱瘘可能被视为腹腔镜手术的禁忌证。腹腔镜治疗复杂性憩室炎和混合性憩室瘘的可行性已得到证实。然而，关于腹腔镜治疗憩室性结肠膀胱瘘的研究很少。对15例憩室性结肠膀胱瘘患者进行了回顾性分析，这些患者接受了腹腔镜辅助前切除术和膀胱修复术。中位手术时间为135分钟，中位失血量为75毫升。5例患者转为开放手术（33.3%），住院时间相应延长（P = 0.035）。肠道功能恢复的中位时间为2天，中位住院时间为6天。总体发病率为20%，无重大并发症。无死亡病例。在中位随访12.4个月期间无复发。这些结果表明，在具备适当手术专业知识的情况下，腹腔镜治疗憩室性结肠膀胱瘘是可行且安全的。
