Kourtesis G J, Williams R A, Wilson S E
Department of Surgery, Harbor/UCLA Medical Center, UCLA School of Medicine, Torrance.
Aust N Z J Surg. 1988 Dec;58(12):955-9. doi: 10.1111/j.1445-2197.1988.tb00100.x.
The outcome of 78 patients hospitalized with acute diverticulitis was analysed to determine the indications for emergency operation and to examine the safety of sigmoid resection. Forty patients improved on medical therapy, but four relapsed soon after discharge. Forty-two (55%) patients had emergency operations for non-resolution of clinical sepsis (25), persistent symptoms or mass (14) and fistula (three). Operations performed were: sigmoid resection and primary anastomosis (23) with covering colostomy (six). Hartmann's operation (10), drainage with/without colostomy (seven) and right hemicolectomy (two). Findings at operation were: abscess (19), phlegmon (14), generalized peritonitis (six), colovesical fistula (three) and chronic diverticulitis (three). Complications included wound infections (six), respiratory complications (five) and one death. Six patients having drainage of the sigmoid inflammation alone as the first operation required subsequent resection, with prolonged and often complicated hospitalization. Minimal morbidity and shorter hospitalization were achieved when sigmoid resection was performed at the initial procedure.
分析了78例因急性憩室炎住院患者的治疗结果，以确定急诊手术的指征并评估乙状结肠切除术的安全性。40例患者经药物治疗后病情好转，但4例在出院后不久复发。42例（55%）患者因临床脓毒症未缓解（25例）、症状持续或有肿块（14例）以及瘘管形成（3例）而接受了急诊手术。所施行的手术包括：乙状结肠切除并一期吻合（23例）及附加保护性结肠造口术（6例）。哈特曼手术（10例）、引流术（伴或不伴结肠造口术，7例）以及右半结肠切除术（2例）。术中所见包括：脓肿（19例）、蜂窝织炎（14例）、弥漫性腹膜炎（6例）、结肠膀胱瘘（3例）以及慢性憩室炎（3例）。并发症包括伤口感染（6例）、呼吸系统并发症（5例）以及1例死亡。6例首次手术仅行乙状结肠炎症引流的患者随后需要进行切除术，住院时间延长且往往病情复杂。初次手术即行乙状结肠切除术时，发病率最低且住院时间较短。
