Department of General Surgery, Cumberland Infirmary, Carlisle, UK.
Colorectal Dis. 2012 Feb;14(2):135-42. doi: 10.1111/j.1463-1318.2011.02606.x.
Currently in the UK the standard surgical practice for the management of perforated sigmoid diverticulitis is a Hartmann's procedure. There have been a number of recent publications on the use of laparoscopic peritoneal lavage for perforated sigmoid diverticulitis, as an alternative to the emergency Hartmann's procedure, with its associated morbidity and mortality. We aim to review the current literature on this topic.
A search was made on the electronic database MEDLINE from PubMed, EMBASE and the Cochrane library. The keywords 'diverticulitis', 'perforated' and 'laparoscopy' were searched for in the titles and abstracts without language restrictions. Further studies were identified from searches on Google Scholar, as well as manual searches through reference lists of the relevant studies found. All included studies were quality assessed.
Twelve relevant studies were included. A total of 301 patients were reported, with a mean age of 57 years. All were non-randomized studies. The majority of patients were of Hinchey classification III. All were treated with intravenous antibiotics followed by laparoscopic lavage and insertion of intra-abdominal/pelvic drains. The mean conversion rate was 4.9% and mean length of hospital stay was 9.3 days. The mean complication rate was 18.9% and the overall mortality rate was 0.25%. Subsequent elective resections with primary anastamosis were performed in 51% of patients and the majority were completed laparoscopically.
Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis appears to be a potentially effective and more conservative alternative to a Hartmann's procedure. Randomized control trials are needed to better evaluate its role.
目前在英国，治疗穿孔乙状结肠憩室炎的标准手术方法是 Hartmann 手术。最近有许多关于腹腔镜腹腔灌洗治疗穿孔乙状结肠憩室炎的出版物，作为紧急 Hartmann 手术的替代方法，其相关的发病率和死亡率较低。我们旨在回顾该主题的当前文献。
在电子数据库 MEDLINE 上，从 PubMed、EMBASE 和 Cochrane 图书馆进行了搜索。在标题和摘要中没有语言限制地搜索了“憩室炎”、“穿孔”和“腹腔镜”等关键词。还通过 Google Scholar 以及手动搜索相关研究的参考文献列表找到了其他研究。对所有纳入的研究进行了质量评估。
共纳入 12 项相关研究。共报告了 301 例患者，平均年龄为 57 岁。所有研究均为非随机研究。大多数患者为 Hinchey 分类 III 期。所有患者均接受静脉内抗生素治疗，随后行腹腔镜灌洗和腹腔/盆腔引流管置入。平均转化率为 4.9%，平均住院时间为 9.3 天。平均并发症发生率为 18.9%，总死亡率为 0.25%。随后对 51%的患者进行了选择性切除术和一期吻合术，大多数患者通过腹腔镜完成。
腹腔镜腹腔灌洗治疗穿孔乙状结肠憩室炎似乎是 Hartmann 手术的一种有效且更保守的替代方法。需要随机对照试验来更好地评估其作用。
