Shephard A A, Keighley M R
Ann R Coll Surg Engl. 1986 Jan;68(1):8-10.
Seventy-three patients were seen between 1970 and 1983 with complicated diverticular disease. There were only six hospital deaths (8%). Two out of 7 patients with faecal peritonitis died, 2 of 27 patients with purulent peritonitis died and there was one death each associated with an inflammatory mass and a peridiverticular abscess. Five of the six hospital deaths were from cardiorespiratory disease and only one was from sepsis. Three of the early deaths were in patients who were receiving steroid therapy. There were three late deaths: one from uncontrolled sepsis, one an anaesthetic death from coronary occlusion during revision of a Hartmann operation and the third was an incidental myocardial infarction. A very conservative surgical policy was adopted, primary resection only being used for an inflammatory mass and selectively for fistula and local purulent disease. Despite our apparent low hospital mortality there was a high incidence of complication; wound sepsis 29%, fistula after colostomy closure 12% and anastomotic dehiscence after primary or secondary reconstruction 12%. These findings indicate the need for a prospective audit which is now in progress.
1970年至1983年间，共诊治了73例复杂性憩室病患者。仅6例患者在医院死亡（8%）。7例粪性腹膜炎患者中有2例死亡，27例脓性腹膜炎患者中有2例死亡，炎性包块和憩室周围脓肿各导致1例死亡。6例医院死亡患者中有5例死于心肺疾病，仅1例死于败血症。3例早期死亡发生在接受类固醇治疗的患者中。有3例晚期死亡：1例死于无法控制的败血症，1例在哈特曼手术翻修期间因冠状动脉闭塞死于麻醉，第3例死于偶发心肌梗死。我们采取了非常保守的手术策略，仅对炎性包块采用一期切除，对瘘管和局部脓性疾病选择性采用一期切除。尽管我们医院的死亡率明显较低，但并发症发生率却很高；伤口感染率为29%，结肠造口关闭后瘘管形成率为12%，一期或二期重建后吻合口裂开率为12%。这些结果表明需要进行前瞻性审计，目前审计正在进行中。
