Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland.
Department of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
Langenbecks Arch Surg. 2021 Feb;406(1):121-129. doi: 10.1007/s00423-020-02015-6. Epub 2020 Oct 20.
The management of perforated diverticulitis with generalized peritonitis is still controversial and no preferred standardized therapeutic approach has been determined. We compared surgical outcomes between Hartmann's procedure (HP) and primary anastomosis (PA) in patients with Hinchey III and IV perforated diverticulitis.
Multicenter retrospective analysis of 131 consecutive patients with Hinchey III and IV diverticulitis operated either with HP or PA from 2015 to 2018. Postoperative morbidity was compared after adjustment for known risk factors in a multivariate logistic regression.
Sixty-six patients underwent HP, while PA was carried out in 65 patients, 35.8% of those were defunctioned. HP was more performed in older patients (74.6 vs. 61.2 years, p < .001), with Hinchey IV diverticulitis (37% vs. 7%, p < .001) and in patients with worse prognostic scores (P-POSSUM Physiology Score, p < .001, Charlson Comorbidity Index p < .001). Major morbidity and mortality were higher in HP compared to PA (30.3% vs. 9.2%, p = .002 and 10.6% vs. 0%, p = .007, respectively) with lower stoma reversal rate (43.9% vs. 86.9%, p < .001). In a multivariate logistic regression, PA was independently associated with lower postoperative morbidity and mortality (OR 0.24, 95% CI 0.06-0.96, p = .044).
In comparison to PA, HP is associated with a higher morbidity, higher mortality, and a lower stoma reversal rate. Although a higher prevalence of risk factors in HP patients may explain these outcomes, a significant increase in morbidity and mortality persisted in a multivariate logistic regression analysis that was stratified for the identified risk factors.
伴有弥漫性腹膜炎的穿孔性憩室炎的处理仍存在争议，尚无确定的首选标准化治疗方法。我们比较了希氏 III 型和 IV 型穿孔性憩室炎患者行Hartmann 手术（HP）和一期吻合术（PA）的手术结果。
回顾性分析 2015 年至 2018 年间 131 例接受 HP 或 PA 治疗的希氏 III 型和 IV 型憩室炎患者的多中心数据。多变量逻辑回归分析调整了已知的风险因素后，比较了术后并发症。
66 例患者行 HP，65 例行 PA，其中 35.8%的患者行预防性造口术。HP 组患者年龄更大（74.6 岁 vs. 61.2 岁，p < 0.001），Hinchey IV 型憩室炎比例更高（37% vs. 7%，p < 0.001），预后评分更差（P-POSSUM 生理学评分，p < 0.001，Charlson 合并症指数 p < 0.001）。HP 组的主要并发症发生率和死亡率明显高于 PA 组（30.3% vs. 9.2%，p = 0.002 和 10.6% vs. 0%，p = 0.007），造口还纳率更低（43.9% vs. 86.9%，p < 0.001）。多变量逻辑回归分析显示，PA 与术后并发症和死亡率降低独立相关（OR 0.24，95%CI 0.06-0.96，p = 0.044）。
与 PA 相比，HP 与更高的发病率、死亡率和更低的造口还纳率相关。尽管 HP 患者的风险因素更为普遍，但在多变量逻辑回归分析中，对确定的风险因素进行分层后，发病率和死亡率仍显著增加。
