Funariu Gheorghe, Binţinţan Vasile, Seicean Radu
1st Surgical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2006 Mar;15(1):37-40.
The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula.
In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively.
Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations.
Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition.
本回顾性研究的目的是评估结肠憩室危及生命并发症的急诊手术治疗。
在过去11年中，101例结肠憩室患者中有22例（22.1%）因急性并发症接受了急诊手术：伴有弥漫性腹膜炎的穿孔性坏疽性憩室炎（n = 8）或结肠周围脓肿（n = 8）、急性肠梗阻（n = 4）和严重憩室出血（n = 2）。在所有弥漫性腹膜炎或急性梗阻患者中，手术指征根据临床情况决定，复杂憩室仅在术中识别。
急诊手术策略因并发症类型和患者生物学状况而异：憩室穿孔（n = 4）、结肠狭窄（n = 3）或憩室出血（n = 2）行节段性结肠切除术和一期吻合术；憩室穿孔（n = 5）或结肠梗阻（n = 1）患者行Hartmann切除术并延迟行再吻合术；一般状况较差的憩室穿孔患者行憩室切除术加腹膜引流（n = 2）以及结肠造口术和引流术，随后二期行结肠切除术（n = 5）。仅1例患者（4.5%）术后因弥漫性腹膜炎导致多器官功能衰竭死亡。一期吻合患者未发生吻合口漏。6例患者（27.2%）发生伤口感染。住院时间为11至60天，二期手术患者明显更长。
对于生物学状态良好的患者，一期结肠切除术加即刻或延迟吻合术是治疗急性憩室并发症的最佳手术方法。对于病情严重且生物学状况危急的患者，结肠造口术和引流术加二期结肠切除术等二期手术仍是可行的选择。
