Stevenson A R, Stitz R W, Lumley J W, Fielding G A
Department of Surgery, Royal Brisbane Hospital, Australia.
Ann Surg. 1998 Mar;227(3):335-42. doi: 10.1097/00000658-199803000-00004.
The objectives of this study were to refine the technique of laparoscopically assisted anterior resection (LAR) for diverticular disease and to analyze the morbidity and mortality rates, and longer term follow-up of the first 100 consecutive patients.
Data were collected prospectively, and follow-up was performed by an independent assessor using a standardized questionnaire.
The median duration of surgery was 180 minutes, the median time for passage of flatus was 2 days after surgery, and the median length of hospital stay was 4 days. Overall, the morbidity rate was 21%, and the wound infection rate was 5%. There were no deaths. Eight patients underwent open laparotomy. The rate of complications was significantly greater in the latter group of patients (75%) than in those who underwent laparoscopy (16%, p = 0.002). The comparison between the first 20 cases and the last 20 patients revealed a significantly shorter duration of surgery (median 225 min. vs. 150 min.; p < 0.0001) and decreased length of stay (6 days vs. 4 days, p < 0.0001). Apart from a nonsignificant increase in the length of surgery, there were no differences in other study parameters when comparisons were made between those patients who underwent LAR for complicated diverticular disease and those patients who underwent uncomplicated diverticular disease.
FOLLOW-UP: Ninety patients were available for follow-up at a median time of 37 months. Ninety-three percent of the patients reported that the surgery had improved their symptoms. No patient required hospitalization, and no one was treated with antibiotics for recurrent symptoms.
Laparoscopically assisted anterior resection for diverticular disease has acceptable morbidity and mortality rates and a median postoperative hospital stay of only 4 days. Follow-up investigations revealed no recurrence of diverticulitis, and patients reported satisfaction regarding cosmetic and functional results.
本研究的目的是完善腹腔镜辅助前切除术（LAR）治疗憩室病的技术，并分析前100例连续患者的发病率、死亡率及长期随访情况。
前瞻性收集数据，由独立评估者使用标准化问卷进行随访。
手术中位时长为180分钟，术后排气中位时间为2天，住院中位时长为4天。总体发病率为21%，伤口感染率为5%。无死亡病例。8例患者接受了开腹手术。后一组患者的并发症发生率（75%）显著高于接受腹腔镜手术的患者（16%，p = 0.002）。前20例与后20例患者的比较显示，手术时长显著缩短（中位时长分别为225分钟和150分钟；p < 0.0001），住院时长也有所减少（分别为6天和4天，p < 0.0001）。除手术时长无显著增加外，对因复杂性憩室病接受LAR手术的患者与因非复杂性憩室病接受手术的患者进行比较时，其他研究参数并无差异。
90例患者可进行随访，中位随访时间为37个月。93%的患者报告手术改善了他们的症状。无患者需要住院治疗，也无人因症状复发接受抗生素治疗。
腹腔镜辅助前切除术治疗憩室病的发病率和死亡率可接受，术后中位住院时长仅为4天。随访调查显示憩室炎无复发，患者对美容和功能效果表示满意。
