腹腔镜灌洗治疗伴有脓性腹膜炎的穿孔性憩室炎可行且安全：随机对照试验DILALA的初步结果
Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis: The First Results From the Randomized Controlled Trial DILALA.
作者信息
Angenete Eva, Thornell Anders, Burcharth Jakob, Pommergaard Hans-Christian, Skullman Stefan, Bisgaard Thue, Jess Per, Läckberg Zoltan, Matthiessen Peter, Heath Jane, Rosenberg Jacob, Haglind Eva
机构信息
*Department of Surgery, Institute of Clinical Sciences, Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden †Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark ‡Department of Surgery, Skaraborgs Hospital, Skovde, Sweden §GastroUnit, Surgical Division, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark ¶Department of Surgery, Roskilde Hospital, Denmark ||NÄL Hospital Group, Trollhättan, Sweden **Department of Surgery, Örebro University Hospital, Örebro, Sweden.
出版信息
Ann Surg. 2016 Jan;263(1):117-22. doi: 10.1097/SLA.0000000000001061.
OBJECTIVE
To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.
BACKGROUND
Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.
METHODS
Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.
RESULTS
Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.
CONCLUSIONS
In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.
目的
在一项随机对照试验中评估一种治疗伴有脓性腹膜炎的穿孔性憩室炎的新疗法的短期疗效。
背景
伴有脓性腹膜炎的穿孔性憩室炎（欣奇 III 级）传统上采用包括结肠切除和造口术（哈特曼手术）在内的手术治疗，术后发病率和死亡率较高。腹腔镜灌洗术被认为是一种侵入性较小的手术治疗方法。
方法
在一项随机对照多中心试验DILALA（ISRCTN82208287）中，将腹腔镜灌洗术与结肠切除和造口术进行比较。最初诊断性腹腔镜检查显示为欣奇 III 级后进行随机分组。收集术后12周内的临床数据。
结果
83例患者被随机分组，其中39例行腹腔镜灌洗术，36例行哈特曼手术，两组患者均可供分析。与哈特曼手术相比，腹腔镜灌洗术后的发病率和死亡率无差异。腹腔镜灌洗术手术时间更短，在恢复室停留时间更短，住院时间更短。
结论
在本试验中，腹腔镜灌洗术作为治疗欣奇 III 级穿孔性憩室炎患者的方法在短期内是可行且安全的。
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