Abbas Saleh
Department of Surgery, Auckland Hospital, Grafton, Auckland, New Zealand.
Int J Colorectal Dis. 2007 Apr;22(4):351-7. doi: 10.1007/s00384-005-0059-4. Epub 2006 Jan 7.
To determine the safety and feasibility of primary resection and anastomosis with or without a diverting stoma, as compared to Hartmann's procedure, for patients with acute complicated sigmoid diverticulitis.
MEDLINE was searched for studies and trials conducted between 1966 and December 2003. This search revealed trials comparing primary resection and anastomosis to Hartmann's procedure. The term "diverticulitis, colonic" with the sub-heading "surgery" was used and the search was limited to human studies and clinical trials. Additional studies were found using the MeSH terms: "surgical procedures, operative", "surgical anastomosis", and "Hartmann procedure", combined with the term "diverticulitis, colonic". The author also searched EMBASE and the Cochrane database for clinical trials using similar terminology. No language restrictions were applied.
Eighteen studies met the inclusion criteria and reported 884 patients with acute complicated diverticulitis. None of these studies were randomised; it is likely that there was a significant degree of selection bias. No significant differences were found between primary resection with anastomosis and Hartmann's procedure with respect to mortality, morbidity, sepsis, wound complications and duration of procedure and anti-biotic treatment. Some studies found that primary anastomosis and a protecting stoma, with or without intra-operative colonic lavage, have more favourable results than Hartmann's procedure.
This review suggests that surgical resection and primary anastomosis in acute diverticulitis with peritonitis compares favourably with Hartmann's procedure in terms of peri-operative complications. The need for revision of Hartmann's procedure could be subsequently avoided. Some articles showed that patients with severe peritonitis, who had a diverting stoma, in the setting of resection and primary anastomosis, had the lowest complication rate. However, the quality of these studies was poor with the presence of selection bias.
确定对于急性复杂性乙状结肠憩室炎患者，与Hartmann手术相比，一期切除吻合术（无论是否行转流造口）的安全性和可行性。
检索MEDLINE中1966年至2003年12月期间开展的研究和试验。该检索揭示了比较一期切除吻合术与Hartmann手术的试验。使用了主题词“结肠憩室炎”及副标题“外科手术”，检索仅限于人体研究和临床试验。使用医学主题词（MeSH）“外科手术， operative”、“外科吻合术”和“Hartmann手术”，并结合“结肠憩室炎”一词，发现了更多研究。作者还使用类似术语在EMBASE和Cochrane数据库中检索临床试验。未应用语言限制。
18项研究符合纳入标准，报告了884例急性复杂性憩室炎患者。这些研究均未进行随机分组；很可能存在显著程度的选择偏倚。在死亡率、发病率、脓毒症、伤口并发症、手术持续时间和抗生素治疗方面，一期切除吻合术与Hartmann手术之间未发现显著差异。一些研究发现，无论是否行术中结肠灌洗，一期吻合术加保护性造口比Hartmann手术有更有利的结果。
本综述表明，在急性憩室炎伴腹膜炎患者中，手术切除及一期吻合术在围手术期并发症方面与Hartmann手术相比具有优势。随后可避免Hartmann手术的翻修需求。一些文章表明，在切除及一期吻合术中行转流造口的重症腹膜炎患者并发症发生率最低。然而，这些研究质量较差，存在选择偏倚。
