Marcucci Tommaso, Giannessi Sandro, Giudici Francesco, Riccadonna Sara, Gori Agnese, Tonelli Francesco
Ann Ital Chir. 2017;88:55-61.
This study aims evaluate the effectiveness of various surgical techniques in treating diverticular fistulas, and the safety and efficacy of the laparoscopic procedure comparing our results with those of the literature.
This was a prospective and uncontrolled study performed at a general surgery units. Between 2005 and 2011, 16 patients (11 men, 5 women) underwent surgery for diverticular fistulas. The mean age was 70.2 (range, 35-87) years. The medical evaluation of these patients was based on symptoms and diagnostic procedures confirming the diagnosis of diverticular fistulas. Our surgical options included one-stage, two-stage, and defunctioning procedures.
Out of 16 cases of diverticular fistula 14 were colovesical and 2 colovaginal. One-stage procedure was performed in 12 patients, two-stage procedure in 3 and defunctioning colostomy in 1. The overall complication rate was 31.2%. We recorded 1 colovesical recurrent fistula. The laparoscopic surgery was performed in 4 patients, nobody was converted to open and there were no post-operative complications and recurrence.
The data show that one-stage procedure is effective in the majority of cases of diverticular fistulas. However, the surgery of colovesical and colovaginal fistulas is often associated to high complication rates. This is often due to the shoddy clinical conditions and long-term diverticular illness of this group of patients. At present, the laparoscopy in an elective setting is not considered any more a contraindication in the treatment of diverticular fistulas.
Diverticular fistulas, Laparoscopic surgery.
本研究旨在评估各种手术技术治疗憩室瘘的有效性，以及将腹腔镜手术的安全性和疗效与文献报道结果进行比较。
这是一项在普通外科病房进行的前瞻性非对照研究。2005年至2011年期间，16例患者（11例男性，5例女性）接受了憩室瘘手术。平均年龄为70.2岁（范围35 - 87岁）。这些患者的医学评估基于症状和确诊憩室瘘的诊断程序。我们的手术选择包括一期手术、二期手术和转流手术。
16例憩室瘘病例中，14例为结肠膀胱瘘，2例为结肠阴道瘘。12例患者接受了一期手术，3例接受了二期手术，1例接受了转流结肠造口术。总体并发症发生率为31.2%。我们记录到1例结肠膀胱复发性瘘。4例患者接受了腹腔镜手术，无一例转为开放手术，且无术后并发症和复发。
数据表明，一期手术在大多数憩室瘘病例中是有效的。然而，结肠膀胱瘘和结肠阴道瘘手术常伴有高并发症发生率。这通常归因于该组患者较差的临床状况和长期的憩室疾病。目前，在选择性情况下，腹腔镜手术不再被视为治疗憩室瘘的禁忌证。
憩室瘘；腹腔镜手术
