Venara A, Toqué L, Barbieux J, Cesbron E, Ridereau-Zins C, Lermite E, Hamy A
L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
J Visc Surg. 2015 Sep;152(4):211-5. doi: 10.1016/j.jviscsurg.2015.04.001. Epub 2015 May 6.
The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease.
This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction.
Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention.
Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance.
关于憩室炎继发狭窄的文献较少。在这种情况下，狭窄应作为手术指征，原因如下：（a）存在癌症潜在风险；（b）与其他结肠切除术指征相比，发病率并未增加。本报告的目的是研究因乙状结肠憩室病相关狭窄行乙状结肠切除术后患者的手术并发症及生活质量。
这是一项单中心回顾性观察研究，纳入2007年1月1日至2013年12月31日期间因术前诊断为乙状结肠憩室病相关狭窄而接受手术的患者。采用胃肠道生活质量指数评估患者满意度。
共纳入16例患者，其中9例为女性。中位年龄为69.5岁（46 - 84岁），中位体重指数为23.55kg/m²（17.2 - 28.4）。所有16例患者均接受了择期乙状结肠切除术。总体而言，5例患者（31.2%）出现并发症（根据Dindo和Clavien分类，4例为轻微并发症，1例为严重并发症）；无一例导致死亡。病理检查发现2例腺癌（12.5%）。胃肠道生活质量指数平均为122（67 - 144），11例患者中有10例对手术干预满意。
乙状结肠狭窄妨碍对整个结肠进行内镜检查，因此可能难以排除恶性肿瘤。手术并未损害生活质量，因为其发病率与乙状结肠切除术的其他指征相似。基于这些原因，我们建议乙状结肠憩室病相关狭窄应作为乙状结肠切除术的指征，包括淋巴结清扫。
