Kiely Maria X, Yao Mengdi, Chen Lilian
Department of Surgery, Division of Colon and Rectum Surgery, Tufts Medical Center, Boston, Massachusetts.
Clin Colon Rectal Surg. 2021 Mar;34(2):104-112. doi: 10.1055/s-0040-1716702. Epub 2021 Feb 24.
Diverticulitis manifestations may cover a spectrum of mild local inflammation to diffuse feculent peritonitis. Up to 35% of patients presenting with diverticulitis will have purulent (Hinchey grade III) or feculent (Hinchey grade IV) contamination of the abdomen, with a high-associated morbidity and mortality. Surgical management may involve segmental resection with or without restoration of bowel continuity. However, emergency resection for diverticulitis can be associated with high mortality rates, as well as low stoma reversal rates at 1 year. Therefore, laparoscopic peritoneal lavage has been proposed for use in selected patients with purulent peritonitis. The topic of laparoscopic peritoneal lavage for the treatment of perforated diverticulitis in the literature has been controversial. Our review of the recent data show that laparoscopic lavage may be safe and feasible in select patients with similar rates of mortality and major morbidity. There is, however, a concern regarding an associated higher rate of postoperative abscess and early reintervention risk.
憩室炎的表现范围可从轻度局部炎症到弥漫性粪性腹膜炎。高达35%的憩室炎患者会出现腹部脓性（欣奇分级III级）或粪性（欣奇分级IV级）污染，伴有较高的相关发病率和死亡率。手术治疗可能包括肠段切除，可选择吻合或不吻合恢复肠道连续性。然而，憩室炎的急诊切除可能与高死亡率相关，且1年时造口回纳率较低。因此，有人提出对部分脓性腹膜炎患者采用腹腔镜腹腔灌洗术。腹腔镜腹腔灌洗术治疗穿孔性憩室炎这一话题在文献中一直存在争议。我们对近期数据的回顾表明，腹腔镜灌洗术在部分患者中可能是安全可行的，死亡率和主要发病率相似。然而，有人担心术后脓肿发生率较高以及早期再次干预风险较大。
