Sher M E, Agachan F, Bortul M, Nogueras J J, Weiss E G, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 W. Cypress Creek Road, Fort Lauderdale, FL 33309, USA.
Surg Endosc. 1997 Mar;11(3):264-7. doi: 10.1007/s004649900340.
Resection of diverticular disease may be quite challenging; the acute inflammatory process, thick sigmoid mesentery, and any associated fistula or abscess can make this procedure technically demanding. The aim of this study was to compare the results between laparoscopic and laparotomy-type resections stratified by disease severity and thereby predict outcome and possibly a subset of patients who may benefit from a laparoscopic approach.
From August 1991 to December 1995, all patients with diverticular disease were classified according to a modified Hinchey classification system. The laparoscopic group included 18 patients who underwent a laparoscopic assisted colectomy, one with a loop ileostomy. The identical procedures were performed in 18 patients by laparotomy. The mean age of the two groups were 62.8 and 67.1 years, respectively (p = NS).
Seven of 18 patients in whom laparoscopy was attempted (38.9%) had conversion to laparotomy. Six of seven (85.7%) conversions were directly related to the intense inflammatory process. Laparoscopic treated patients with Hinchey IIa or IIb disease had a morbidity rate of 33.3% and a conversion rate of 50% while all patients with Hinchey I disease were successfully completed without morbidity or conversions to laparotomy. However, after the first four cases, the intraoperative morbidity and postoperative morbidity rates were zero and 14.3% and after ten cases they were zero and zero, respectively. Furthermore, the median length of hospitalization for Hinchey I patients after laparoscopy was 5.0 days vs 7 days after laparotomy (p < 0.05). In Hinchey IIa and IIb patients, the median length of hospitalization was almost 50% shorter with a laparoscopic approach (6 days vs 10 days, p < 0.05).
In conclusion, laparoscopic resection of diverticulitis can be performed without additional morbidity particularly in Hinchey I patients and with a reduced length of hospitalization in patients with class I or II disease. Patients with class I disease, and after initial experience even those with class II disease, can benefit from the reduced morbidity and length of hospitalization associated with laparoscopic treatment.
憩室病的切除可能颇具挑战性；急性炎症过程、增厚的乙状结肠系膜以及任何相关的瘘管或脓肿会使该手术在技术上要求较高。本研究的目的是比较按疾病严重程度分层的腹腔镜手术和开腹手术切除的结果，从而预测预后，并可能找出可能从腹腔镜手术中获益的患者亚组。
1991年8月至1995年12月，所有憩室病患者均根据改良的欣奇分类系统进行分类。腹腔镜组包括18例行腹腔镜辅助结肠切除术的患者，其中1例行回肠袢式造口术。18例患者通过开腹进行相同的手术。两组的平均年龄分别为62.8岁和67.1岁（p = 无显著性差异）。
18例尝试腹腔镜手术的患者中有7例（38.9%）中转开腹。7例中转患者中有6例（85.7%）与强烈的炎症过程直接相关。腹腔镜治疗的欣奇IIa或IIb期疾病患者的发病率为33.3%，中转率为50%，而所有欣奇I期疾病患者均成功完成手术，无发病或中转开腹情况。然而，在前4例之后，术中发病率和术后发病率分别为零和14.3%，10例之后分别为零和零。此外，腹腔镜手术后欣奇I期患者的中位住院时间为5.0天，而开腹手术后为7天（p < 0.05）。在欣奇IIa和IIb期患者中，腹腔镜手术的中位住院时间几乎缩短了50%（6天对10天，p < 0.05）。
总之，腹腔镜切除憩室炎尤其在欣奇I期患者中可无额外发病情况进行，且I或II级疾病患者的住院时间缩短。I级疾病患者，以及在有了初步经验后，即使是II级疾病患者，都可从与腹腔镜治疗相关的发病率降低和住院时间缩短中获益。
