Myers E, Hurley M, O'Sullivan G C, Kavanagh D, Wilson I, Winter D C
Institute for Clinical Outcomes Research and Education at Saint Vincent's University Hospital, Dublin, Ireland.
Br J Surg. 2008 Jan;95(1):97-101. doi: 10.1002/bjs.6024.
The standard approach to generalized peritonitis due to perforated diverticulitis involves open surgery and diversion of faecal content. This study assessed the feasibility of laparoscopic peritoneal lavage.
A prospective multi-institutional study of 100 patients was undertaken. All consenting patients with perforated diverticulitis causing generalized peritonitis underwent attempted laparoscopic peritoneal lavage. The degree of peritonitis, according to the Hinchey grading system, was recorded. Primary endpoints were operative success and resolution of symptoms.
Patients had a median age of 62.5 (range 39-94) years, a male : female ratio of 2 : 1 and a median American Society of Anesthesiologists grade of III (range II-V). Eight patients with grade 4 diverticulitis had conversion to an open Hartmann's procedure. The remaining 92 patients were managed by laparoscopic lavage, with morbidity and mortality rates of 4 and 3 per cent respectively. Two patients required postoperative intervention for a pelvic abscess. Only two patients re-presented with diverticulitis at a median follow up of 36 (range 12-84) months.
Laparoscopic management of perforated diverticulitis with generalized peritonitis is feasible, with a low recurrence risk in the short term.
因穿孔性憩室炎导致的弥漫性腹膜炎的标准治疗方法包括开放手术和粪便转流。本研究评估了腹腔镜下腹腔灌洗的可行性。
对100例患者进行了一项前瞻性多机构研究。所有同意参与的因穿孔性憩室炎导致弥漫性腹膜炎的患者都尝试进行了腹腔镜下腹腔灌洗。根据欣奇分级系统记录腹膜炎的程度。主要终点是手术成功和症状缓解。
患者的中位年龄为62.5岁（范围39 - 94岁），男女比例为2∶1，美国麻醉医师协会中位分级为III级（范围II - V级）。8例4级憩室炎患者转为行开放性哈特曼手术。其余92例患者采用腹腔镜灌洗治疗，发病率和死亡率分别为4%和3%。2例患者因盆腔脓肿需要术后干预。在中位随访36个月（范围12 - 84个月）时，只有2例患者再次出现憩室炎。
腹腔镜治疗穿孔性憩室炎合并弥漫性腹膜炎是可行的，短期内复发风险较低。
