Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
Int J Colorectal Dis. 2013 Apr;28(4):447-57. doi: 10.1007/s00384-012-1622-4. Epub 2012 Dec 15.
This manuscript is a review of different surgical techniques to manage perforated colon diverticulitis.
This study was conducted to compare the benefits and disadvantages of different surgical treatments for Hinchey III or IV type of colon diverticulitis.
A systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, and the Science Citation Index (1990 and 2011). A total of 1,809 publications were identified and 14 studies with 1,041 patients were included in the study. Any surgical treatment was considered in this review. Mortality was considered the primary outcome, whereas hospital stay and reoperation rate were considered secondary outcomes.
Primary resection with anastomosis has a significant advantage in terms of lower mortality rate with respect to Hartmann's procedure (P = 0.02). The postoperative length of hospitalization was significantly shorter in the resection with anastomosis group (P < 0.001). Different findings have emerged from studies of patients with the primary resection with anastomosis vs laparoscopic peritoneal lavage and subsequent resection: overall surgical morbidity and hospital stay were lower in the laparoscopic peritoneal lavage group compared to the primary resection and anastomosis group (P < 0.001).
Despite numerous published articles on operative treatments for patients with generalized peritonitis from perforated diverticulitis, we found a marked heterogeneity between included studies limiting the possibility to summarize in a metanalytical method the data provided and make difficult to synthesize data in a quantitative fashion. The advantages in the group of colon resection with primary anastomosis in terms of lower mortality rate and postoperative stay should be interpreted with caution because of several limitations. Future randomized controlled trials are needed to further evaluate different surgical treatments for patients with generalized peritonitis from perforated diverticulitis.
本文是对不同手术技术治疗穿孔性结肠憩室炎的综述。
本研究旨在比较不同手术治疗希氏Ⅲ或Ⅳ型结肠憩室炎的优缺点。
系统检索 Medline、Embase、 Cochrane 对照试验中心注册库和科学引文索引（1990 年和 2011 年）。共检索到 1809 篇文献，纳入 14 项研究共 1041 例患者。本综述考虑了任何手术治疗。死亡率被认为是主要结局，而住院时间和再次手术率被认为是次要结局。
与 Hartmann 手术相比，一期切除吻合术在死亡率方面具有显著优势（P = 0.02）。一期切除吻合术组的术后住院时间明显缩短（P < 0.001）。对于行一期切除吻合术与腹腔镜腹腔灌洗及随后切除的患者，不同研究结果如下：与一期切除吻合术组相比，腹腔镜腹腔灌洗组的总体手术并发症和住院时间较低（P < 0.001）。
尽管有大量关于穿孔性憩室炎所致弥漫性腹膜炎患者手术治疗的已发表文章，但我们发现纳入的研究之间存在显著异质性，限制了对提供的数据进行荟萃分析并难以以定量方式综合数据的可能性。一期结肠切除吻合术组死亡率和术后住院时间较低的优势应谨慎解释，因为存在一些局限性。需要进一步开展随机对照试验来评估不同手术治疗穿孔性憩室炎所致弥漫性腹膜炎的效果。
