根据适应证对择期乙状结肠切除术治疗憩室炎的手术结果进行分层：一项 903 例患者的倾向评分匹配队列研究。
Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients.
机构信息
Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
出版信息
Langenbecks Arch Surg. 2023 Aug 3;408(1):295. doi: 10.1007/s00423-023-03034-9.
OBJECTIVE
Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication.
METHODS
All patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed.
RESULTS
585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001).
CONCLUSION
The lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.
目的
无论特定的憩室炎分类如何，都要权衡择期乙状结肠切除术的围手术期风险。本研究的目的是根据分类等级和适应证评估手术结果。
方法
纳入研究的所有患者均在十年研究期间因憩室炎而行择期结肠切除术。他们分为两组：相对手术适应证（RSI）和绝对手术适应证（ASI）。RSI 包括微脓肿和复发性单纯性疾病。ASI 包括大脓肿和复发性复杂性疾病。进行倾向评分匹配（PSM，1:1）。
结果
585 例患者符合 RSI 标准，318 例患者符合 ASI 标准。在单因素分析中，RSI 患者年龄较小（62 岁 vs. 67.7 岁，p<0.001），身体状况较好（ASA 评分 1 或 2 的患者占 80.7% vs. 60.8%，p<0.001），免疫抑制程度较低（3.4% vs. 6.9%，p=0.021），冠心病发病率较低（3.8% vs. 7.2%，p=0.025）。PSM 后，选择 318 例 RSI 与 318 例 ASI 患者；基线特征结果相当。RSI 中计划腹腔镜切除术的比例为 93%，而 ASI 中为 75%（p<0.001），RSI 中转开腹手术的比例为 5.0%，而 ASI 中转开腹手术的比例为 13.8%，差异有统计学意义（p<0.001）。RSI 中主要并发症（Clavien/Dindo≥IIIb）发生率较低（3.77% vs. 10%，p=0.003）。RSI 中形成预防性造口的比例为 0.9%，而 ASI 中为 11.0%（p<0.001）。
结论
与复杂性憩室炎或伴有大脓肿的憩室炎患者相比，复发性单纯性憩室炎或伴有微脓肿的憩室炎患者术后发生并发症的风险较低，腹腔镜切除的机会更高，造口形成的几率更低，这一点即使在 PSM 后仍然适用。
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