Golda T, Kreisler E, Mercader C, Frago R, Trenti L, Biondo S
Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
Colorectal Dis. 2014 Sep;16(9):723-31. doi: 10.1111/codi.12685.
Immunosuppression is believed to worsen outcomes for patients who require surgery for perforated diverticulitis. The aim of this study was to compare surgical outcomes between immunocompromised and immunocompetent patients undergoing surgery for complicated diverticulitis.
All patients who underwent emergency surgery for complicated diverticulitis between 2004 and 2012 in a single unit were studied. Patients were classified as immunosuppressed (group I) or immunocompetent (group II). Operation type and postoperative morbidity and mortality were compared between groups. The impact of operating surgeons' specialization and the Peritonitis Severity Score (PSS) were also evaluated to determine their impact on the restoration of gastrointestinal (GI) continuity.
One-hundred and sixteen patients (mean age: 63.7 years), 41.4% women, were included. Fifty-three (45.7%) patients were immunosuppressed (group I): 42 underwent Hartmann's procedure (HP) (79.2%), nine (17.0%) underwent resection and primary anastomosis (RPA) with ileostomy (IL) and two (3.8%) underwent RPA without IL. In group II, 15 HP (23.8%), nine RPA with IL (14.3%) and 39 RPA without IL (61.9%) were performed. Postoperative morbidity and mortality were 79.2% and 26.4%, respectively, in group I and 63.5% and 6.3%, respectively, in group II. The overall mean PSS was 9.5, with a mean PSS of 11.1 in group I and of 8.1 in group II. The decision to perform a primary anastomosis differed significantly between colorectal surgeons and general surgeons in the patients with a PSS of 9-10-11.
In immunocompromised patients, RPA with IL can be a safe surgical option, whereas HP should be reserved for patients with a PSS of > 11. Colorectal surgical specialization is associated with higher rates of restoration of GI continuity in patients with perforated diverticulitis, especially in patients with an intermediate PSS score. Evaluation of each patient's PSS facilitates decision making in surgery for perforated diverticulitis.
免疫抑制被认为会使因穿孔性憩室炎而需要手术的患者预后恶化。本研究的目的是比较免疫功能低下和免疫功能正常的复杂性憩室炎手术患者的手术结局。
对2004年至2012年在单一科室接受复杂性憩室炎急诊手术的所有患者进行研究。患者分为免疫抑制组（I组）和免疫功能正常组（II组）。比较两组的手术类型、术后发病率和死亡率。还评估了手术医生的专业程度和腹膜炎严重程度评分（PSS）对胃肠道（GI）连续性恢复的影响。
共纳入116例患者（平均年龄：63.7岁），女性占41.4%。53例（45.7%）患者为免疫抑制（I组）：42例行Hartmann手术（HP）（79.2%），9例行带回肠造口术（IL）的切除及一期吻合术（RPA）（17.0%），2例行不带IL的RPA（3.8%）。在II组中，15例行HP（23.8%），9例行带IL的RPA（14.3%），39例行不带IL的RPA（61.9%）。I组术后发病率和死亡率分别为79.2%和26.4%，II组分别为63.5%和6.3%。总体平均PSS为9.5，I组平均PSS为11.1，II组为8.1。在PSS为9 -
