Parisi Amilcare, Gemini Alessandro, Desiderio Jacopo, Petrina Adolfo, Trastulli Stefano, Grassi Veronica, Sani Marco, Pironi Daniele, Santoro Alberto
Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy.
Department of General Surgery, St. Maria della Misericordia's Hospital, University of Perugia, Perugia, Italy.
Wideochir Inne Tech Maloinwazyjne. 2016;11(2):83-7. doi: 10.5114/wiitm.2016.60236. Epub 2016 May 31.
Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery.
This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis.
We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy.
The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%.
Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.
多年来，已开发出多种治疗憩室炎的技术。腹腔镜腹膜灌洗（LPL）似乎是一种安全且有用的治疗方法，在急诊手术中它可能是结肠切除的有效替代方法。
这项前瞻性观察性研究旨在评估腹腔镜腹膜灌洗在穿孔性乙状结肠憩室炎中的安全性和益处。
我们对70例复杂乙状结肠憩室炎患者进行了紧急手术治疗。32例（45.7%）患者接受了乙状结肠切除术并进行了结肠造口术（哈特曼技术）；21例（30%）患者接受了腹腔镜腹膜灌洗；4例（5.7%）患者采用米库利奇技术进行了结肠造口术；其余13例（18.6%）患者接受了乙状结肠切除术并进行了结直肠吻合术及保护性回肠造口术。
接受检查的66例患者分为3组：32例患者根据哈特曼手术进行了急诊手术治疗；13例患者接受了切除术和结直肠吻合术；21例患者接受了腹腔镜腹膜灌洗急诊治疗。我们没有术中并发症。总死亡率为4.3%（3例患者）。在LPL组中，发病率为33.3%。
目前尚不能说LPL在死亡率和发病率方面比结肠切除术更好。然而，通过在选择接受腹腔镜腹膜灌洗的患者时给予更多关注，这些数据可能会被证明是错误的。
