Lin Hongwei, Zhuang Zhuonan, Huang Xin, Li Yuanxin
Department of Gastrointestinal Surgery.
Center of Hepatopancreatobiliary Diseases, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Medicine (Baltimore). 2020 Oct 2;99(40):e22421. doi: 10.1097/MD.0000000000022421.
Laparoscopic surgery develops rapidly in both elective and emergency settings. The study aimed to determine the role of different laparoscopic methods for the emergency treatment of complicated diverticulitis.
MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane database were searched up to November 2019 to identify all published articles related to the topic. Statistical analysis was performed using Stata 15.
Fourteen publications were included in the analysis. Laparoscopic surgery was applied in 425 patients, and 493 patients underwent open colon resection (OCR). Postoperative mortality, morbidity, severe complications, and reoperation rates were not significantly different between the laparoscopic and open surgery groups. Subgroup analysis was performed based on the different laparoscopic methods (laparoscopic colon resection [LCR] and laparoscopic lavage and drainage [LLD]). Subgroup analysis indicated that LCR was superior to OCR in terms of morbidity, while OCR was superior to LLD in terms of severe complications.
The safety of laparoscopic surgery for the emergency treatment of complicated diverticulitis is related to different surgical methods. LCR is suggested to be a better choice according to the postoperative outcomes. More definite conclusions can be drawn in future randomized controlled trials.
腹腔镜手术在择期和急诊手术中均发展迅速。本研究旨在确定不同腹腔镜手术方法在复杂憩室炎急诊治疗中的作用。
检索截至2019年11月的MEDLINE、EMBASE、科学引文索引扩展版和Cochrane数据库，以识别所有已发表的与该主题相关的文章。使用Stata 15进行统计分析。
14篇出版物纳入分析。425例患者接受了腹腔镜手术，493例患者接受了开放性结肠切除术（OCR）。腹腔镜手术组和开放手术组的术后死亡率、发病率、严重并发症和再次手术率无显著差异。基于不同的腹腔镜手术方法（腹腔镜结肠切除术[LCR]和腹腔镜灌洗引流术[LLD]）进行亚组分析。亚组分析表明，LCR在发病率方面优于OCR，而OCR在严重并发症方面优于LLD。
腹腔镜手术用于复杂憩室炎急诊治疗的安全性与不同的手术方法有关。根据术后结果，建议LCR是更好的选择。未来的随机对照试验可得出更明确的结论。
