Cady J, Godfroy J, Sibaud O
Chirurgie. 1996;121(5):350-3; discussion 353-4.
From 1992 to 1995, 77 cases of diverticular sigmoiditis were treated laparoscopically. Conversion to open surgery was required in only 6 cases. There were 27 cases with perforated sigmoid including 5 with peritonitis. Leakages from the anastomosis occurred intraoperatively in 3 cases and were repaired laparoscopically. Early complications were fistulae (n = 2.3%), occlusion by loop agglutination (n = 1) and Richter's hernia (n = 1). A cerebral vascular event lead to death in one patient over 80. Late complications were limited to extensible anastomotic diaphragms (27%) as no true stenoses were observed. There was 1 occlusion on bride and 1 eventration through the extraction orifice. Both were treated laparoscopically. Our overall results after laparoscopic treatment of diverticular sigmoiditis show a 3-fold increase in operative time over classical surgery without any modification in operative risks, a 2-fold reduction in intensive care after surgery and preserved parietal wall (10-fold reduction in the number of eventrations and to a lesser extent fewer occlusions). Laparoscopic surgery does however have its limitations in major peritoneo-occlusive syndromes and in patients with a high risk for anesthesia.
1992年至1995年，对77例乙状结肠憩室炎患者进行了腹腔镜治疗。仅6例需要转为开腹手术。有27例乙状结肠穿孔患者，其中5例伴有腹膜炎。术中3例吻合口漏，均经腹腔镜修复。早期并发症包括瘘（n = 2.3%）、肠袢粘连梗阻（n = 1）和里脱疝（n = 1）。1例80多岁的患者因脑血管事件死亡。晚期并发症仅限于可扩张的吻合口隔膜（27%），未观察到真正的狭窄。有1例桥接处梗阻和1例通过取出孔发生的腹壁疝。均经腹腔镜治疗。我们对乙状结肠憩室炎进行腹腔镜治疗后的总体结果显示，手术时间比传统手术增加了3倍，手术风险无任何改变，术后重症监护时间减少了2倍，腹壁得以保留（腹壁疝数量减少了10倍，梗阻数量减少程度较小）。然而，腹腔镜手术在主要的腹膜闭塞综合征和麻醉风险高的患者中确实存在局限性。
