Institute for Clinical Outcomes Research & Education and Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
Dis Colon Rectum. 2012 Sep;55(9):932-8. doi: 10.1097/DCR.0b013e31826178d0.
Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.
This study investigated national trends in management of perforated diverticulitis.
This retrospective population study used an Irish national database to identify patients acutely admitted with diverticulitis, as defined by the International Classification of Diseases. Demographics, procedures, comorbidities, and outcomes were obtained for the years 1995 to 2008.
The study was conducted in Ireland.
Patients with International Classification of Diseases codes corresponding to diverticulitis who underwent operative intervention were included.
The primary outcome was mortality, and secondary outcomes were length of stay and postoperative complications.
Two thousand four hundred fifty-five patients underwent surgery for diverticulitis, of whom 427 underwent laparoscopic lavage. Patients selected for laparoscopic lavage had lower mortality (4.0% vs 10.4%, p < 0.001), complications (14.1% vs 25.0%, p < 0.001), and length of stay (10 days vs 20 days, p < 0.001) than those requiring laparotomy/resection. Patients older than 65 years were more likely to die (OR 4.1, p < 0.001), as were those with connective tissue disease (OR 7.3, p < 0.05) or chronic kidney disease (OR 8.0, p < 0.001).
This retrospective study is limited by the quality of data obtained and is subject to selection bias. Furthermore, the lack of disease stratification means it is not possible to identify the extent of peritonitis; feculent peritonitis has worse outcomes and is not likely to be included in the lavage group.
The number of patients selected for laparoscopic lavage in perforated diverticulitis is increasing, and the outcomes in this study are comparable to other reports. Those patients in whom laparoscopic lavage alone was suitable had lower mortality and morbidity than those in whom resection was considered necessary.
腹腔镜灌洗在非脓性穿孔性憩室炎中显示出良好的效果。它是一种有吸引力的策略；它避免了与切除相关的并发症。然而，由于缺乏大规模的研究，人们对其广泛采用有些犹豫不决。
本研究调查了穿孔性憩室炎治疗的国家趋势。
这项回顾性的人群研究使用爱尔兰国家数据库来确定 1995 年至 2008 年期间以国际疾病分类为标准的急性憩室炎患者。获取了患者的人口统计学、手术程序、合并症和结果。
研究在爱尔兰进行。
纳入了符合国际疾病分类代码的接受手术干预的憩室炎患者。
主要结果是死亡率，次要结果是住院时间和术后并发症。
2455 例患者因憩室炎接受手术治疗，其中 427 例行腹腔镜灌洗。接受腹腔镜灌洗的患者死亡率（4.0%比 10.4%，p<0.001）、并发症（14.1%比 25.0%，p<0.001）和住院时间（10 天比 20 天，p<0.001）均低于需要剖腹手术/切除的患者。年龄大于 65 岁的患者死亡风险更高（OR 4.1，p<0.001），患有结缔组织疾病（OR 7.3，p<0.05）或慢性肾脏病（OR 8.0，p<0.001）的患者也是如此。
这项回顾性研究受到所获得数据质量的限制，并受到选择偏倚的影响。此外，由于缺乏疾病分层，无法确定腹膜炎的程度；脓性腹膜炎的预后更差，不太可能被纳入灌洗组。
在穿孔性憩室炎中选择腹腔镜灌洗的患者数量正在增加，本研究的结果与其他报告相似。那些适合单独进行腹腔镜灌洗的患者的死亡率和发病率低于那些认为有必要进行切除的患者。
