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首页> 外文期刊>Surgical Endoscopy >Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.
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Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.

机译：腹腔镜切除乙状结肠憩室炎。多中心研究的结果。腹腔镜结直肠外科研究小组。

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BACKGROUND: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number of publications involving case series or the results of highly experienced individual surgeons already have confirmed the feasibility of laparoscopic resection in cases of diverticulitis. The aim of the present prospective multicentric investigation was to check the results obtained by a large number of surgeons performing laparoscopic resection of the sigmoid colon for diverticulitis in various stages of severity. RESULTS: Between January 8, 1995 and January 1, 1998, the Laparoscopic Colorectal Surgery Study Group recruited 1,118 patients to the prospective multicenter study. Diverticulitis of the sigmoid colon, which accounted for 304 cases, was the most common indication for laparoscopic intervention. In most of these patients undergoing laparoscopic surgery (81.9%), the diverticulitis manifested as acute phlegmonous peridiverticulitis, recurrent attacks of inflammation, or stenosis. Complicated forms of diverticulitis in Hinchey stages I to IV and late complications of chronic diverticular disease with fistula formation and bleeding accounted for only 18.1% of the cases. For the overall group, the conversion rate was 7.2%. Patients with less severe diverticulitis (i.e., those presenting with peridiverticulitis, stenosis, or recurrent attacks of inflammation) had a conversion rate of 4.8% and the rate for complicated cases was 18.2%. Regarding laparoscopically completed interventions, 3 of 282 patients died (1.1%). In the group of patients with peridiverticulitis, stenosis, or recurrent attacks of inflammation the overall complication rate was 14.8%. The group with perforated diverticulitis in Hinchey stages I to IV or those with fistula and bleeding, the corresponding rate was 28.9%, and after conversion it was 31.8%. CONCLUSIONS: Laparoscopic colorectal interventions in sigmoid diverticulitis are, for the most part, carried out as elective procedures for peridiverticulitis, stenosis, or recurrent attacks of inflammation. The conversion, complication, and mortality rates associated with these interventions are acceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverticulitis and in the presence of fistula and bleeding are more likely to be associated with complications, and should be carried out only by highly experienced laparoscopic surgeons.
机译：背景：在大肠中，乙状结肠切除术是最常进行的腹腔镜手术，因为大肠病变通常位于肠的这一部分，从技术上讲，该手术是最有利的。许多涉及病例系列的出版物或经验丰富的个体外科医生的结果已经证实腹腔镜切除术在憩室炎病例中的可行性。本项前瞻性多中心研究的目的是检查在严重程度各不相同的情况下，大量外科医师通过腹腔镜切除乙状结肠的憩室炎所获得的结果。结果：在1995年1月8日至1998年1月1日之间，腹腔镜结直肠外科手术研究小组招募了1118例患者进行前瞻性多中心研究。乙状结肠憩室炎占304例，是腹腔镜手术最常见的适应症。在大多数接受腹腔镜手术的患者中（81.9％），憩室炎表现为急性痰性憩室炎，反复发作的炎症或狭窄。 Hinchey I至IV期的憩室炎的复杂形式以及慢性憩室疾病的晚期并发症，瘘管形成和出血仅占病例的18.1％。对于整个小组，转化率为7.2％。轻度憩室炎较轻的患者（即表现为憩室周围炎，狭窄或炎症反复发作的患者）的转化率为4.8％，复杂病例的转化率为18.2％。关于腹腔镜完成的干预措施，在282例患者中有3例死亡（1.1％）。在憩室周围炎，狭窄或炎症反复发作的患者中，总并发症发生率为14.8％。 Hinchey I至IV期穿孔性憩室炎或有瘘管和出血的组，相应率为28.9％，转换后为31.8％。结论：腹腔镜大肠直肠切除术对乙状结肠憩室炎的治疗主要是针对憩室周围炎，狭窄或炎症反复发作的选择性手术。与这些干预措施相关的转化率，并发症和死亡率是可以接受的。 Hinchey I至IV期乙状结肠憩室炎以及存在瘘管和出血的腹腔镜手术更有可能与并发症相关，应仅由经验丰富的腹腔镜手术医师进行。

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