S状結腸憩室炎に対する手術適応，術式および治療成績に関する検討
【目的】当院でのS状結腸憩室炎手術症例の臨床的特徴と手術成績を明らかにし，治療方針の再評価を行った．【方法】2009年1月から2018年2月までに経験した28例を後方視的に検討した．【成績】待機群（8例）と緊急群（20例）の検討では，待機群で全例に切除吻合術が施行され，Clavien-Dindo分類（CD）II以上の合併症を認めなかった．緊急群で14例にHartmann手術が施行され，CDII以上の合併症を5例に認めた．緊急群をHincheyI・II（11例）とIII・IV（9例）に分けた検討では，HincheyI・IIで出血量が多いが，術後合併症の発生に差を認めなかった．腹腔鏡（6例）と開腹...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 72; no. 6; pp. 381 - 387 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大腸肛門病学会
2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.72.381 |
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| Abstract | 【目的】当院でのS状結腸憩室炎手術症例の臨床的特徴と手術成績を明らかにし，治療方針の再評価を行った．【方法】2009年1月から2018年2月までに経験した28例を後方視的に検討した．【成績】待機群（8例）と緊急群（20例）の検討では，待機群で全例に切除吻合術が施行され，Clavien-Dindo分類（CD）II以上の合併症を認めなかった．緊急群で14例にHartmann手術が施行され，CDII以上の合併症を5例に認めた．緊急群をHincheyI・II（11例）とIII・IV（9例）に分けた検討では，HincheyI・IIで出血量が多いが，術後合併症の発生に差を認めなかった．腹腔鏡（6例）と開腹手術（22例）の検討では，腹腔鏡群で出血量が少なく，術後合併症の発生を認めなかった．【結語】Hinchey分類に基づいた治療方針の決定と待機的腹腔鏡手術の選択が治療成績向上のために重要である． |
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| AbstractList | 【目的】当院でのS状結腸憩室炎手術症例の臨床的特徴と手術成績を明らかにし，治療方針の再評価を行った．【方法】2009年1月から2018年2月までに経験した28例を後方視的に検討した．【成績】待機群（8例）と緊急群（20例）の検討では，待機群で全例に切除吻合術が施行され，Clavien-Dindo分類（CD）II以上の合併症を認めなかった．緊急群で14例にHartmann手術が施行され，CDII以上の合併症を5例に認めた．緊急群をHincheyI・II（11例）とIII・IV（9例）に分けた検討では，HincheyI・IIで出血量が多いが，術後合併症の発生に差を認めなかった．腹腔鏡（6例）と開腹手術（22例）の検討では，腹腔鏡群で出血量が少なく，術後合併症の発生を認めなかった．【結語】Hinchey分類に基づいた治療方針の決定と待機的腹腔鏡手術の選択が治療成績向上のために重要である． |
| Author | 柿澤, 奈緒 前本, 遼 石川, 英樹 田巻, 佐和子 高橋, 洵 菊川, 利奈 力山, 敏樹 長谷川, 芙美 宮倉, 安幸 辻仲, 眞康 町田, 枝里華 |
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| References | 12) Bolkenstein HE, Consten ECJ, van der Palen J, et al: Dutch Diverticular Disease (3D) Collaborative Study Group. Long-term outcome of surgery versus conservative management for recurrent and ongoing complaints after an episode of diverticulitis: 5-year follow-up results of a multicenter randomized controlled trial (DIRECT-Trial). Ann Surg 269:612-620, 2019 23) Norman G, Jane V, Uri N, et al: Laparoscopic Lavage in the Management of Perforated Diverticulitis: a Contemporary Meta-analysis. J Gastrointest Surg 21:1491-1499, 2017 5) Kanda Y: Investigation of the freely available easy-to-use software ‘EZR' for medical statistics. Bone Marrow Transplantation 48:452-458, 2013 3) Sher ME, Agachan F, Bortul M, et al: Laparoscopic surgery for diverticulitis. Surg Endosc 11:264-267, 1997 21) 中野悠平, 黒崎哲也, 松本浩次ほか:HincheyI, II大腸憩室炎に対する腹腔鏡手術. 日本大腸肛門病会誌 71:9-12, 2018 14) Khan RMA, Hajibandeh S, Hajibandeh S: Early elective versus delayed elective surgery in acute recurrent diverticulitis: A systematic review and meta-analysis. Int J Surg 46:92-101, 2017 15) Cristina MP, Gregory DK, Evie HC, et al: National trends in short-term outcomes following non-emergent surgery for diverticular disease. J Gastrointest Surg 20:1376-1387, 2016 19) Tochigi T, Kosugi C, Shuto K, et al: Management of complicated diverticulitis of the colon. Ann Gastroenterol Surg 2:22-27, 2018 17) 金子奉暁, 船橋公彦, 小池淳一ほか:大腸憩室炎によるS状結腸膀胱瘻に対する腹腔鏡下手術の3例の経験と本邦報告24例の文献的考察. 日本大腸肛門病会誌 67:536-541, 2014 22) 真岸亜希子, 植松 大, 秋山 岳ほか:大腸穿孔による汎発性腹膜炎に対する腹腔鏡下Hartmann手術46例の検討. 日鏡外会誌 23:593-600, 2018 13) Warwas FB, Schneider B: Elective vs. early elective surgery in diverticular disease: a retrospective study on the optimal timing of non-emergency treatment. Int J Colorectal Dis 33:531-539, 2018 24) Binda GA, Bonino MA, Siri G, et al: Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO study). Br J Surg 105:1835-1843, 2018 16) 山口茂樹, 田代 浄, 石井利明ほか:大腸憩室炎に対する待機的手術 特に腹腔鏡下S状結腸切除の現状について. 日本大腸肛門病会誌 61:1026-1030, 2008 8) Elagili F, Stocchi L, Ozuner G, et al: Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess. Tech Coloproctol 19:97-103, 2015 2) Hinchey EJ, Schaal PG, Richards GK: Treatment of perforated diverticular disease of the colon. Adv Surg 12:85-109, 1978 9) Brandhuber M, Genzinger C, Brandlhuber B, et al: Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis. Int J Colorectal Dis 33:317-326, 2018 1) 貝瀬 満, 石井直樹, 瓜田純久ほか:大腸憩室症（憩室出血・憩室炎）ガイドライン. 日消化管会誌 1:1-52, 2017 4) Wasvary H, Turfah F, Kadro O, et al: Same hospitalization resection for acute diverticulitis. Am Surg 65:632-635, 1999 6) Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a surgery. Ann Surg 240:205-213, 2004 11) Regenet N, Pessaux P, Hennekinne S, et al: Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18:503-507, 2003 7) Andeweg CS, Mulder IM, Felt-Bersma RJ, et al: Guidelines of diagnostics and treatment of acute left- sided colonic diverticulitis. Dig Surg 30:278-292, 2013 20) Reissfelder C, Buhr HJ, Ritz JP: What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection? Dis Colon Rectum 49:1842-1848, 2006 10) Mbadiwe T, Obirieze AC, Cornwell EE 3rd, et al: Surgical management of complicated diverticulitis: a comparison of the laparoscopic and open approaches. J Am Coll Surg 216:782-788, 2013 18) 富沢賢治, 花岡 裕, 戸田重夫ほか:腹腔鏡下手術を施行したS状結腸憩室炎による結腸膀胱瘻の検討. 日鏡外会誌 17:753-759, 2012 |
| References_xml | – reference: 14) Khan RMA, Hajibandeh S, Hajibandeh S: Early elective versus delayed elective surgery in acute recurrent diverticulitis: A systematic review and meta-analysis. Int J Surg 46:92-101, 2017 – reference: 21) 中野悠平, 黒崎哲也, 松本浩次ほか:HincheyI, II大腸憩室炎に対する腹腔鏡手術. 日本大腸肛門病会誌 71:9-12, 2018 – reference: 3) Sher ME, Agachan F, Bortul M, et al: Laparoscopic surgery for diverticulitis. Surg Endosc 11:264-267, 1997 – reference: 2) Hinchey EJ, Schaal PG, Richards GK: Treatment of perforated diverticular disease of the colon. Adv Surg 12:85-109, 1978 – reference: 24) Binda GA, Bonino MA, Siri G, et al: Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO study). Br J Surg 105:1835-1843, 2018 – reference: 22) 真岸亜希子, 植松 大, 秋山 岳ほか:大腸穿孔による汎発性腹膜炎に対する腹腔鏡下Hartmann手術46例の検討. 日鏡外会誌 23:593-600, 2018 – reference: 9) Brandhuber M, Genzinger C, Brandlhuber B, et al: Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis. Int J Colorectal Dis 33:317-326, 2018 – reference: 5) Kanda Y: Investigation of the freely available easy-to-use software ‘EZR' for medical statistics. Bone Marrow Transplantation 48:452-458, 2013 – reference: 12) Bolkenstein HE, Consten ECJ, van der Palen J, et al: Dutch Diverticular Disease (3D) Collaborative Study Group. Long-term outcome of surgery versus conservative management for recurrent and ongoing complaints after an episode of diverticulitis: 5-year follow-up results of a multicenter randomized controlled trial (DIRECT-Trial). Ann Surg 269:612-620, 2019 – reference: 11) Regenet N, Pessaux P, Hennekinne S, et al: Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18:503-507, 2003 – reference: 6) Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a surgery. Ann Surg 240:205-213, 2004 – reference: 7) Andeweg CS, Mulder IM, Felt-Bersma RJ, et al: Guidelines of diagnostics and treatment of acute left- sided colonic diverticulitis. Dig Surg 30:278-292, 2013 – reference: 15) Cristina MP, Gregory DK, Evie HC, et al: National trends in short-term outcomes following non-emergent surgery for diverticular disease. J Gastrointest Surg 20:1376-1387, 2016 – reference: 1) 貝瀬 満, 石井直樹, 瓜田純久ほか:大腸憩室症（憩室出血・憩室炎）ガイドライン. 日消化管会誌 1:1-52, 2017 – reference: 23) Norman G, Jane V, Uri N, et al: Laparoscopic Lavage in the Management of Perforated Diverticulitis: a Contemporary Meta-analysis. J Gastrointest Surg 21:1491-1499, 2017 – reference: 16) 山口茂樹, 田代 浄, 石井利明ほか:大腸憩室炎に対する待機的手術 特に腹腔鏡下S状結腸切除の現状について. 日本大腸肛門病会誌 61:1026-1030, 2008 – reference: 19) Tochigi T, Kosugi C, Shuto K, et al: Management of complicated diverticulitis of the colon. Ann Gastroenterol Surg 2:22-27, 2018 – reference: 17) 金子奉暁, 船橋公彦, 小池淳一ほか:大腸憩室炎によるS状結腸膀胱瘻に対する腹腔鏡下手術の3例の経験と本邦報告24例の文献的考察. 日本大腸肛門病会誌 67:536-541, 2014 – reference: 10) Mbadiwe T, Obirieze AC, Cornwell EE 3rd, et al: Surgical management of complicated diverticulitis: a comparison of the laparoscopic and open approaches. J Am Coll Surg 216:782-788, 2013 – reference: 4) Wasvary H, Turfah F, Kadro O, et al: Same hospitalization resection for acute diverticulitis. Am Surg 65:632-635, 1999 – reference: 13) Warwas FB, Schneider B: Elective vs. early elective surgery in diverticular disease: a retrospective study on the optimal timing of non-emergency treatment. Int J Colorectal Dis 33:531-539, 2018 – reference: 18) 富沢賢治, 花岡 裕, 戸田重夫ほか:腹腔鏡下手術を施行したS状結腸憩室炎による結腸膀胱瘻の検討. 日鏡外会誌 17:753-759, 2012 – reference: 8) Elagili F, Stocchi L, Ozuner G, et al: Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess. Tech Coloproctol 19:97-103, 2015 – reference: 20) Reissfelder C, Buhr HJ, Ritz JP: What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection? Dis Colon Rectum 49:1842-1848, 2006 |
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| Title | S状結腸憩室炎に対する手術適応，術式および治療成績に関する検討 |
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