West Hertfordshire Hospitals NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0BU UK.
World J Emerg Surg. 2019 Jul 11;14:32. doi: 10.1186/s13017-019-0251-4. eCollection 2019.
Surgical management of Hinchey III and IV diverticulitis utilizes either Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. The aim of this meta-analysis is to determine which of the two procedures has a more favorable outcome.
A systematic review of the existing literature was performed using the PRISMA guidelines. A meta-analysis was carried out using a Mantel-Haenszel, random effects model, and forest plots were generated. The Newcastle-Ottawa and Jadad scoring tools were used to assess the included studies.
A total of 25 studies involving 3546 patients were included in this study. The overall mortality in the HP group was 10.8% across the observational studies and 9.4% in the randomized controlled trials (RCTs). The mortality rate in the PRA group was lower than that in the HP group, at 8.2% in the observational studies and 4.3% in the RCTs. A comparison of PRA vs HP demonstrated a 40% lower mortality rate in the PRA group than in the HP (OR 0.60, 95% CI 0.38-0.95, = 0.03) when analyzing the observational studies. However, meta-analysis of the three RCTs did not demonstrate any difference in mortality, (OR 0.44 (95% CI 0.14-1.34, = 0.15). Wound infection rates between the two groups were comparable (OR 0.75, 95% CI 0.20-2.78, = 0.67).
Analysis of observational studies suggests that PRA may be associated with a lower overall mortality. There were no differences in wound infection rates. Based on the current evidence, both surgical strategies appear to be acceptable.
希恩（Hinchey）III 级和 IV 级憩室炎的手术治疗方法可采用哈氏（Hartmann）手术（HP）或一期切除吻合术（PRA），可加或不加粪便转流。本荟萃分析旨在确定两种手术方法中哪一种具有更好的效果。
采用 PRISMA 指南对现有文献进行系统评价。采用 Mantel-Haenszel 随机效应模型进行荟萃分析，并生成森林图。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）和 Jadad 评分工具评估纳入的研究。
共有 25 项研究，涉及 3546 例患者纳入本研究。观察性研究中 HP 组的总体死亡率为 10.8%，随机对照试验（RCT）中为 9.4%。PRA 组的死亡率低于 HP 组，观察性研究中为 8.2%，RCT 中为 4.3%。PRA 与 HP 相比，PRA 组的死亡率降低了 40%（OR 0.60，95%CI 0.38-0.95， = 0.03），在分析观察性研究时。然而，对三项 RCT 的荟萃分析并未显示死亡率有任何差异（OR 0.44（95%CI 0.14-1.34， = 0.15）。两组的伤口感染率相当（OR 0.75，95%CI 0.20-2.78， = 0.67）。
分析观察性研究表明，PRA 可能与较低的总体死亡率相关。两组的伤口感染率无差异。根据目前的证据，这两种手术策略似乎都是可以接受的。
