Vetter Diana, Schuurmans Macé M, Benden Christian, Clavien Pierre-Alain, Nocito Antonio
Department of Abdominal- and Transplant Surgery, University Hospital of Zurich, Zurich, Switzerland.
Division of Pulmonology, University Hospital of Zurich, Zurich, Switzerland.
Clin Transplant. 2016 Oct;30(10):1264-1270. doi: 10.1111/ctr.12817. Epub 2016 Sep 27.
We aim to assess the incidence, current treatment, and outcome of diverticulitis in highly immunosuppressed lung transplant recipients.
Retrospective analysis of a prospective database of 403 lung transplant recipients transplanted between 1992 and 2013 with a mean follow-up of 100 months (SD 58.0).
4.46% of lung transplant recipients (n=18) developed diverticulitis. Eight lung transplant recipients developed uncomplicated diverticulitis, which were all treated successfully with antibiotics. Three patients (37.5%) underwent elective sigmoid resection with severe Grade 3b complications after two of five (40%) surgical procedures. Diverticulitis recurrence occurred in five patients (60%). In total, 10 lung transplant recipients presented with 11 episodes of perforated diverticulitis with a 30-day mortality rate of 9.1%. Hartmann procedure was performed in eight lung transplant recipients. Sigmoid resection with primary anastomosis and protective ileostomy was performed in three patients with Hinchey I. Two of these patients developed anastomotic leakage with a secondary Hartmann procedure.
Due to high leakage rate after resection with primary anastomosis and protective ileostomy in our cohort of lung transplant recipients with perforated diverticulitis, the Hartmann procedure seems to be the safer option. In contrast, in uncomplicated diverticulitis, non-operative treatment can be considered as a safe and highly successful treatment option, even for recurrences.
我们旨在评估高度免疫抑制的肺移植受者憩室炎的发病率、当前治疗方法及治疗结果。
对1992年至2013年间接受肺移植的403例受者的前瞻性数据库进行回顾性分析，平均随访100个月（标准差58.0）。
4.46%的肺移植受者（n = 18）发生憩室炎。8例肺移植受者发生非复杂性憩室炎，均通过抗生素治疗成功。3例患者（37.5%）在5次手术中的2次（40%）后因严重的3b级并发症接受了择期乙状结肠切除术。5例患者（60%）憩室炎复发。共有10例肺移植受者出现11次穿孔性憩室炎发作，30天死亡率为9.1%。8例肺移植受者接受了哈特曼手术。3例欣奇I级患者接受了乙状结肠切除并一期吻合及保护性回肠造口术。其中2例患者发生吻合口漏，随后接受了哈特曼手术。
在我们这组穿孔性憩室炎的肺移植受者中，由于一期吻合及保护性回肠造口术后的高漏率，哈特曼手术似乎是更安全的选择。相比之下，在非复杂性憩室炎中，即使复发，非手术治疗也可被视为一种安全且非常成功的治疗选择。
