Zoog Evon, Giles W Heath, Maxwell Robert A
Am Surg. 2017 Dec 1;83(12):1321-1328.
The management of perforated diverticulitis is a challenging aspect of general surgery. The prevalence of colonic diverticular disease has increased over the last decade and will continue to increase as the baby boomers add to the elderly population. Improvements in diagnostic imaging modalities, efforts to maintain intestinal continuity, and percutaneous drainage procedures now result in several alternatives when selecting a management strategy for complicated presentations. Specifically, laparoscopic lavage and resection with primary anastomosis have emerged as options for treatment of Hinchey III and IV diverticulitis in place of diversion in the appropriately selected patient. Percutaneous drainage of Hinchey II diverticulitis in centers equipped with interventional radiology provides another minimally invasive adjunct. The objective of this paper is to provide an update on the current management of perforated diverticulitis, with a focus on the advantages and disadvantages of the surgical options for the treatment of Hinchey III and IV diverticulitis.
穿孔性憩室炎的治疗是普通外科中具有挑战性的一个方面。在过去十年中，结肠憩室病的患病率有所上升，随着婴儿潮一代步入老年人口，其患病率还将继续上升。诊断成像方式的改进、维持肠道连续性的努力以及经皮引流程序，使得在为复杂病情选择治疗策略时出现了多种选择。具体而言，对于适当选择的患者，腹腔镜灌洗和一期吻合切除术已成为治疗欣奇（Hinchey）III级和IV级憩室炎的替代分流术的选择。在配备介入放射学设备的中心，对欣奇II级憩室炎进行经皮引流提供了另一种微创辅助治疗方法。本文的目的是提供关于穿孔性憩室炎当前治疗方法的最新情况，重点关注治疗欣奇III级和IV级憩室炎的手术选择的优缺点。
