Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany,
Int J Colorectal Dis. 2013 Dec;28(12):1681-8. doi: 10.1007/s00384-013-1753-2. Epub 2013 Aug 3.
The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies.
A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire.
A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4-118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien-Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014).
The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease.
对于穿孔性憩室炎患者的理想治疗方法仍存在争议。几十年来，Hartmann 手术一直是首选治疗方法，但带预防性造口的一期吻合术已成为一种公认的替代方法。本研究旨在评估这两种手术策略后的造口逆转率。
回顾性分析 2002 年至 2011 年间接受 Hartmann 手术（HP）与带预防性造口的一期吻合术（PA）治疗的穿孔性乙状结肠憩室炎患者的数据。此外，于 2012 年 3 月使用标准化问卷通过邮件或电话联系患者。
共确定了 98 例患者：72 例行 HP，26 例行 PA。中位随访时间为 63 个月（范围 4-118）。虽然 85%的 PA 患者已行造口逆转，但只有 58%的 HP 患者行造口逆转（p=0.046）。HP 患者行造口逆转的中位时间明显长于 PA（19 周比 12 周；p=0.03）。PA 的 30 天死亡率为 12%，而 HP 为 25%（p=0.167）。根据 Clavien-Dindo 分类，PA 患者的手术并发症发生率明显低于 HP（p=0.014）。
PA 的造口逆转率明显高于 HP。因此，根据整体临床情况，对于穿孔性憩室炎患者，带预防性造口的一期切除术和吻合术可能是一种优化的选择。
