Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
J Gastrointest Surg. 2012 Oct;16(10):1915-22. doi: 10.1007/s11605-012-1977-4. Epub 2012 Jul 28.
With the use of abdominal vacuum therapy, we have developed a damage control concept for patients with perforated diverticulitis and generalized peritonitis. The primary aim of this concept was to enhance recovery and allow bowel reconstruction in a second-look operation.
A total of 51 patients (28 female, 55%) with a median (range) age of 69 (28-87) years, with perforated diverticulitis Hinchey III (n = 40, 78%) or Hinchey IV (n = 11, 22%) and a median (range) Mannheim peritonitis index of 26 (12-39), admitted between October 2006 and September 2011, were prospectively enrolled in the study. At initial operation, limited resection of the diseased segment, lavage, and application of abdominal vacuum-assisted closure dressing was performed. After patient resuscitation, a second look was performed in an elective setting.
Hospital mortality rate was 9.8%; 35 (76%) of patients were discharged with reconstructed colon, and 93% of patients live without a stoma at follow-up. Risk factors for mortality were American Society of Anesthesiologist score (p = 0.01), organ failure at initial presentation (p = 0.03), cardiac comorbidity (p = 0.05), and a Hartmann procedure at second look (p = 0.00).
With this abdominal vacuum-based damage control concept, an acceptable hospital mortality rate and a high rate of bowel reconstruction at second look were achieved in patients with perforated diverticulitis and generalized peritonitis.
通过使用腹部真空治疗，我们为穿孔性憩室炎和弥漫性腹膜炎患者开发了一种损伤控制概念。该概念的主要目的是促进恢复，并允许在二次探查手术中进行肠道重建。
2006 年 10 月至 2011 年 9 月，前瞻性纳入了 51 例穿孔性憩室炎（Hinchey III 级 40 例，78%；Hinchey IV 级 11 例，22%）和弥漫性腹膜炎（Mannheim 腹膜炎指数 26 例，12-39 例）的患者，中位（范围）年龄 69（28-87）岁，其中 28 例为女性（55%）。初次手术时采用局限性病变肠段切除、冲洗和应用腹部真空辅助闭合敷料。患者复苏后，择期进行二次探查。
住院死亡率为 9.8%；35 例（76%）患者出院时结肠重建，93%的患者在随访时无造口。死亡的危险因素包括美国麻醉医师协会评分（p=0.01）、初次表现时器官衰竭（p=0.03）、心脏合并症（p=0.05）和二次探查时行Hartmann 手术（p=0.00）。
采用这种基于腹部真空的损伤控制概念，可使穿孔性憩室炎和弥漫性腹膜炎患者获得可接受的住院死亡率和较高的二次探查时肠道重建率。
