Department of Academic Surgery, Cork University Hospital, Cork, Ireland.
J Gastrointest Surg. 2013 Feb;17(2):369-73. doi: 10.1007/s11605-012-2025-0. Epub 2012 Sep 26.
Non-resectional strategies (NRS) have improved outcomes for a sub-group of patients with perforated diverticulitis. NRS are applicable to patients with non-faeculant peritonitis (Hinchey II and III). Success is dependent on the initial perforation sealing, which Hinchey estimated occurred 'most of the time'. An exact percentage remains ill-defined.
We aimed to define the percentage and clinical significance of a persistent perforation in non-faeculant diverticular peritonitis.
A retrospective review was conducted of all patients admitted with a diagnosis of perforated diverticulitis between January 1999 and July 2010. Patients undergoing an emergency operation were analysed according to Hinchey and physiological and operative severity scores and compared with histological findings.
One hundred fifteen patients were identified. Fifty-three patients underwent a 'resectional' procedure. At surgery, 15 patients had faeculent peritonitis, 27 patients had purulent peritonitis and 11 patients had a contained abscess. Of the patients with non-faeculant peritonitis, 2/9 (22.2 %) Hinchey II and 10/27 (37.1 %) Hinchey III patients had persistent perforation on review of histology. Persistent perforation was associated with a significant increase in morbidity, length of stay, physiological and operative severity score (p = 0.015, 0.011, 0.049 and 0.002, respectively).
A proportion of patients with non-faeculant peritonitis have a persistent perforation which is associated with a poorer outcome and is likely to result in failure of a non-resectional management strategy. Updated classification systems and tailored peri-operative investigations are required to identify this sub-group of patients and improve patient outcomes.
非切除术策略（NRS）已改善了一部分穿孔性憩室炎患者的预后。NRS 适用于非粪便性腹膜炎（Hinchey II 和 III 期）患者。成功与否取决于初始穿孔的封闭，Hinchey 估计“大多数情况下”都会发生这种情况。确切的百分比仍未明确定义。
我们旨在确定非粪便性憩室炎穿孔性腹膜炎中持续性穿孔的百分比及其临床意义。
回顾性分析了 1999 年 1 月至 2010 年 7 月期间所有诊断为穿孔性憩室炎的患者。根据 Hinchey 以及生理和手术严重程度评分，对接受急诊手术的患者进行了分析，并与组织学发现进行了比较。
共确定了 115 例患者。53 例患者接受了“切除术”手术。在手术中，15 例患者患有粪便性腹膜炎，27 例患者患有脓性腹膜炎，11 例患者患有局限性脓肿。在非粪便性腹膜炎患者中，2/9（22.2%）Hinchey II 期和 10/27（37.1%）Hinchey III 期患者的组织学检查发现存在持续性穿孔。持续性穿孔与发病率、住院时间、生理和手术严重程度评分显著增加相关（p=0.015、0.011、0.049 和 0.002）。
一部分非粪便性腹膜炎患者存在持续性穿孔，这与预后较差相关，并且可能导致非切除术管理策略失败。需要更新的分类系统和针对性的围手术期检查来识别这部分患者，并改善患者的预后。
