在急性憩室炎中，直接吻合加转流术是否优于 Hartmann 手术？

Does primary anastomosis with diversion have any advantages over Hartmann's procedure in acute diverticulitis?

机构信息

Department of Surgery, Division of Colorectal Surgery, University of California, Irvine, Medical Center, Orange, CA 92868, USA.

出版信息

Dig Surg. 2012;29(4):315-20. doi: 10.1159/000342549. Epub 2012 Oct 15.

DOI:10.1159/000342549

PMID:23075540

Abstract

BACKGROUND

The optimal treatment for acute complicated diverticulitis is still a matter of debate. We evaluated outcomes of primary anastomosis with proximal diversion (PAD) versus Hartman's procedure (HP) in acute diverticulitis.

METHODS

Using the National Inpatient Sample database, we examined the clinical data of patients who underwent an urgent open colorectal resection (sigmoidectomy or anterior resection) for acute diverticulitis from 2002 to 2007 in the United States. We evaluated patient characteristics, patient comorbidities, perioperative complications, in-hospital mortality, length of hospital stay and total hospital charges between two groups.

RESULTS

A total of 99,259 patients underwent urgent surgery for acute diverticulitis during these years (Primary anastomosis without diversion: 39.3%; HP: 57.3% and PAD: 3.4%). The overall complication rate was lower in the PAD group compared with the HP group (PAD: 39.06% vs. HP: 40.84%; p = 0.04). Patients in the HP group had a shorter mean length of stay (12.5 vs.14.4 days, p < 0.001) and lower mean hospital costs (USD 65,037 vs. USD 73,440, p < 0.01) compared with the PAD group. Mortality was higher in the HP group (4.82 vs. 3.99%, p = 0.03).

CONCLUSION

PAD has improved outcomes compared with HP, and should be considered in patients who are deemed candidates for two-stage operations for acute diverticulitis.

摘要

背景

急性复杂性憩室炎的最佳治疗方法仍存在争议。我们评估了原发性吻合术（PAD）与 Hartman 手术（HP）治疗急性憩室炎的效果。

方法

我们使用国家住院患者样本数据库，在美国 2002 年至 2007 年间检查了因急性憩室炎接受紧急开腹结肠直肠切除术（乙状结肠切除术或前切除术）的患者的临床数据。我们评估了两组患者的特征、患者合并症、围手术期并发症、院内死亡率、住院时间和总住院费用。

结果

在这些年中，共有 99259 例患者因急性憩室炎接受了紧急手术（原发性吻合术不引流：39.3%；HP：57.3%和 PAD：3.4%）。与 HP 组相比，PAD 组的总并发症发生率较低（PAD：39.06%比 HP：40.84%；p = 0.04）。HP 组的平均住院时间更短（12.5 天比 14.4 天，p < 0.001），平均住院费用更低（USD65037 比 USD73440，p < 0.01），与 PAD 组相比。HP 组的死亡率更高（4.82%比 3.99%，p = 0.03）。