Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street # 201F, Worcester, MA 01605, USA.
Int J Surg. 2017 Apr;40:124-129. doi: 10.1016/j.ijsu.2017.02.094. Epub 2017 Mar 1.
Routine splenic flexure mobilization (SFM) has been previously recommended to ensure an adequate length for a tension free anastomosis during resection for diverticulitis. We sought to evaluate the role of selective SFM for diverticulitis, and its impact on outcomes.
Retrospective review of elective colectomies at a tertiary care center (2007-2015) for left-sided diverticulitis were identified from the National Surgical Quality Improvement Program. Demographics and perioperative characteristics were compared; and 30-day risk-adjusted outcomes were assessed.
We identified 208 sigmoid/left colectomy cases. A laparoscopic approach predominated (71%), and SFM was performed in 54% of cases (n = 113). Demographics and comorbidities were similar. Median operative time was greater in the SFM group [226; interquartile range (IQR): (190-267) minutes] compared to no mobilization [180; IQR: (153-209) minutes] (p < 0.01). After risk adjustment, SFM was associated with a trend towards an increased rate of a minor morbidity (OR: 2.8; p = 0.05).
Splenic flexure mobilization was performed selectively in half of colectomies evaluated. This technique was associated with a trend towards an increased rate of minor complications, with no difference in major adverse events, including organ space infections. These findings suggest that for patient with diverticulitis, SFM should be performed in an individualized fashion.
在憩室炎切除术中，为确保吻合无张力，先前推荐常规游离脾曲（SFM）。我们旨在评估选择性游离脾曲在憩室炎中的作用及其对结局的影响。
从国家手术质量改进计划中回顾了 2007 年至 2015 年在三级医疗中心行左半结肠切除术的择期憩室炎患者。比较了人口统计学和围手术期特征；并评估了 30 天风险调整后结局。
我们确定了 208 例乙状结肠/左半结肠切除术病例。腹腔镜方法占主导地位（71%），SFM 在 54%的病例中进行（n=113）。人口统计学和合并症相似。SFM 组的中位手术时间更长[226；四分位距（IQR）：（190-267）分钟]，而非游离组为[180；IQR：（153-209）分钟]（p<0.01）。风险调整后，SFM 与轻微并发症发生率增加呈趋势相关（OR：2.8；p=0.05）。
在评估的结肠切除术患者中，选择性游离脾曲的比例为一半。该技术与轻微并发症发生率增加呈趋势相关，但主要不良事件（包括器官间隙感染）无差异。这些发现表明，对于憩室炎患者，SFM 应个体化实施。
