结肠憩室病致急腹症的诊疗效果分析

目的探讨结肠憩室病的临床特点及腹腔镜下结肠憩室病的手术方式及疗效。 方法回顾性分析2013年6月至2018年7月在广州市花都区人民医院诊断为结肠憩室病的32例患者资料。其中男11例，女21例；憩室发生在直肠4例，乙状结肠2例，左半结肠6例，回盲部20例；2例行腹腔镜检查后因家属拒绝行肠切除，遂终止手术，接受抗感染治疗；30例行肠切除手术，包括乙状结肠切除2例，直肠切除4例，右半结肠切除11例，降结肠部分切除5例，回盲部切除+空肠结肠吻合术8例，其中7例行临时性降结肠造瘘术，半年后行降结肠造瘘回纳术。14例为腹腔镜探查后中转开腹手术，16例为腹腔镜下完成手术。 结果2例抗感染治疗后症状缓解，术后1个月随访，结肠镜检查无阳性，至今憩室炎未复发。30例手术效果满意，术后恢复良好，无手术相关并发症，随访未见腹泻、大便次数增多等不适症状。回盲部切除与右半结肠切除两种术式并发症发生率比较，差异无统计学意义（50.0% vs 36.4%，χ²=1.584，P=0.812）。腔镜手术患者术后胃肠功能恢复较中转开腹手术更快（t=8.062，P<0.01），住院时间更短（t=8.607，P<0.01）。 结论诊断结肠憩室后一期行部分肠切除手术治疗安全、有效，腹腔镜行部分肠切除较传统手术更具优势。

Diagnosis and treatment of acute abdominal disease caused by colonic diverticulum

ObjectiveTo investigate the clinical characteristics of colonic diverticulosis and the surgical method and curative effect of laparoscope in colonic diverticulosis. MethodsFrom June 2013 to July 2018, thirty-two cases of colonic diverticulosis diagnosed in Guangzhou Huadu District People’s Hospital were retrospectively analyzed. There were eleven males and twenty-one females. Diverticles occurred in rectum in four cases, sigmoid colon in two cases, left colon in six cases and ileocecal in twenty cases. The operation was terminated in two cases because the family refused to undergo intestinal resection. Thirty cases underwent intestinal resection, including sigmoidectomy in two cases, rectal resection in four cases, right hemicolectomy in eleven cases, partial resection of descending colon in five cases, ileocecal resection plus jejunocolic anastomosis in eight cases, of which seven cases underwent temporary descending colon fistula and were admitted half a year later. Laparoscopic exploration and conversion to laparotomy were performed in fourteen cases, laparoscopic surgery was performed in sixteen cases. ResultsThe symptoms were relieved after anti-infection treatment in two cases, after 1 month of follow-up, colonoscopy was not positive, and diverticulitis had not recurred so far. Thirty cases gained satisfactory postoperative recovery results, no symptoms such as diarrhea and feces were found during follow-up. There was no significant difference in the incidence of complications between ileocecal resection and right hemicolectomy (50.0% vs36.4%, χ2=1.584, P=0.812). The recovery of gastrointestinal function in laparoscopic surgery group was faster than that in open surgery group (t=8.062, P<0.01), and the hospitalization time was shorter (t=8.607, P<0.01). ConclusionsPartial intestinal resection in the first stage is safe and effective after diagnosis of colonic diverticulum. Laparoscopic partial intestinal resection has more advantages than traditional surgery.