Mari Giulio, Montroni Isacco, Origi Matteo, Crippa Jacopo, Achilli Pietro, Costanzi Andrea, Ferrari Giovanni, Ugolini Giampaolo, Maggioni Dario
Colorectal Department, ASST Monza, Desio Hospital, Desio.
Colorectal Department, Infermi Hospital, Faenza.
Surg Laparosc Endosc Percutan Tech. 2020 Aug 4;31(1):40-43. doi: 10.1097/SLE.0000000000000850.
The current treatment of symptomatic diverticular disease is left colectomy/sigmoidectomy with low ligation of the inferior mesenteric artery versus the inferior mesenteric artery preservation. Up to now, there is no strong evidence in favor of one of the 2 strategies. The aim of this study is to compare the bowel-specific quality of life and functional outcomes between these 2.
Between June 2015 and February 2019, patients were randomly assigned to inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for diverticular disease. Gastrointestinal, genitourinary functions and surgical outcomes were compared postoperatively between groups.
One-hundred sixty-eight patients were randomized providing 2 homogenous groups. Gastrointestinal and genitourinary functions were not significantly different between groups after 1 and 6 months postoperative. In both groups, the function was restored to the preoperative level 6 months after surgery. There was no statistically significant difference in terms of conversion rate, blood loss, length of surgery, between groups. There was no difference in the overall complication rate and the anastomotic leak rate among groups.
Inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for a diverticular disease can be considered equivalent in affecting the postoperative bowel-related quality of life, genitourinary function, and surgical outcomes.
目前，有症状的憩室病的治疗方法是左半结肠切除术/乙状结肠切除术，即低位结扎肠系膜下动脉与保留肠系膜下动脉。到目前为止，尚无有力证据支持这两种策略中的任何一种。本研究的目的是比较这两种策略在肠道特定生活质量和功能结局方面的差异。
2015年6月至2019年2月期间，在因憩室病行择期腹腔镜乙状结肠切除术时，将患者随机分配至肠系膜下动脉低位结扎组或肠系膜下动脉保留组。术后比较两组的胃肠、泌尿生殖功能及手术结局。
168例患者被随机分组，形成两个同质组。术后1个月和6个月时，两组的胃肠和泌尿生殖功能无显著差异。两组患者术后6个月时功能均恢复至术前水平。两组在中转率、失血量、手术时长方面无统计学显著差异。两组在总体并发症发生率和吻合口漏发生率方面无差异。
对于憩室病行择期腹腔镜乙状结肠切除术时，肠系膜下动脉低位结扎或肠系膜下动脉保留在影响术后肠道相关生活质量、泌尿生殖功能及手术结局方面可视为等效。
