결장 게실염 치료 시 복강경 수술의 유용성
Usefulness of Laparoscopic-assisted Surgery for the Treatment of Colonic Diverticulitis
하석효, 김규성, 조해창, 이정안, 배병조,
소속 상세정보
하석효 ( Ha Suk-Hyo )
대구파티마병원 외과
김규성 ( Kim Kyu-Sung )
대구파티마병원 외과
조해창 ( Cho Hae-Chang )
대구파티마병원 외과
이정안 ( Rhee Jung-Ahn )
대구파티마병원 외과
배병조 ( Bae Byung-Jo )
대구파티마병원 외과
KMID : 0356720040200010020
Abstract
Purpose: Colonic diverticulitis was rare in Korea in the past. However, it is progressively increasing probably because of a prolonged life span and a westernized diet pattern. Especially, right-sided colonic diverticulitis is difficult to differentiated from acute appendicitis. The purpose of this study was to verify the usefulness of laparoscopic-assisted surgery for the diagnosis and treatment of colonic diverticulitis.
Methods: We retrospectively reviewed 65 patients with colonic diverticulitis who underwent surgery from January 1998 to December 2002.
Results: The mean age of the patients was 36.3 years. Males were more prevalent than females (1.6：1). Abdominal ultrasonography (USG) was used as a diagnostic tool in 40 cases (61.5%), abdominal USG with colon enema in 8 cases (12.3%), and abdominal USG with abdominal CT in 4 cases (6.2%). The preoperative diagnosis was acute appendicitis in 52 patients (80.0%), perforated diverticulitis in 10 patients (15.4%), peritonitis in 2 patients (3.5%), and peptic ulcer perforation in 1 patient (1.5%). The postoperative diagnosis was simple diverticulitis in 47 cases (72.3%). The cecum was the most commonly involved area (55 cases, 84.6%). The types of open surgery were an appendectomy in 17 cases (26.1%), a right hemicolectomy in 17 cases (26.1%), a cecectomy in 6 cases (9.2%). The types of laparoscopic- assisted surgery were an appendectomy in 17 cases (26.1%), a laparoscopic-assisted right hemicolectomy in 4 cases (6.2%), and an anterior resection in 1 case (1.5%). The postoperative complication rate was 11.9% (5 cases). All of these occurred with the open technique, but no statistically significant difference existed between the complication rates for the two operative procedures (P=0.158). The mortality rate was zero for both operative procedures. The length of hospital stay (4.72±4.3 vs 10.1±6.2)(P=0.001) was significantly shorter in the laparoscopic-assisted group than in the open group.
Conclusions: Preoperative diagnosis is sometimes difficult in patients with colonic diverticulitis. We consider laparoscopic-assisted surgery to be a useful diagnostic and therapeutic modality in such cases. The laparoscopic technique offers particular advantages to diverticulitis patients because of the short hospital stay and the low morbidity and mortality rates. J Korean Soc Coloproctol 2004;20:20-26
키워드
결장 게실염;결장절제술/방법
Diverticulitis;Colonic;Colectomy/method
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