From the Queen's Medical Center (W.L.B.), Honolulu, Hawaii; Department of Surgery (F.A.M.), University of Florida, Gainesville, Florida; and Department of Surgery (E.E.M.), Denver Health Medical Center, Denver, Colorado.
J Trauma Acute Care Surg. 2017 Apr;82(4):810-813. doi: 10.1097/TA.0000000000001390.
Patients with perforated diverticulitis suffer high morbidity and mortality. For decades, sigmoid colectomy with colostomy (Hartman’s procedure) has been considered the standard surgical management. Over the past several years, less-morbid alternatives have been advocated. Laparoscopic lavage showed promise in retrospective studies. However, recent prospective randomized clinical trials have suggested that outcomes may not be better compared with the Hartman’s procedure. A critical analysis of the literature leads the authors to the conclusion that there is still a role for laparoscopic lavage in selected patients, as a bridge to elective colectomy or, in some cases, as definitive management.
患有穿孔性憩室炎的患者发病率和死亡率较高。几十年来，带有结肠造口术的乙状结肠切除术（Hartman 手术）一直被认为是标准的手术治疗方法。在过去的几年中，人们提倡采用创伤更小的替代方法。腹腔镜灌洗在回顾性研究中显示出了前景。然而，最近的前瞻性随机临床试验表明，与 Hartman 手术相比，其结果可能并不更好。对文献的批判性分析使作者得出结论，对于某些特定患者，腹腔镜灌洗仍然具有一定作用，可作为择期结肠切除术的桥梁，或者在某些情况下，作为确定性治疗。
