Tudor R G, Farmakis N, Keighley M R
Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
Br J Surg. 1994 May;81(5):730-2. doi: 10.1002/bjs.1800810537.
Details of 300 patients with complicated diverticular disease from 30 hospitals between 1985 and 1988 were entered into a national audit organized by the Surgical Research Society. Complications present on admission included acute phlegmon (n = 104), pericolic abscess (n = 34), purulent peritonitis (n = 40), large bowel obstruction (n = 31), faecal peritonitis (n = 23), pericolic abscess complicated by fistula (n = 28) and lower gastrointestinal bleeding (n = 40). The overall mortality rate was 11.3 per cent (acute phlegmon, 4 per cent; purulent peritonitis, 27 per cent; pericolic abscess, 12 per cent; faecal peritonitis, 48 per cent; large bowel obstruction, 6 per cent; bleeding, 2 per cent; fistula, 4 per cent). Acute phlegmon was treated without operation in 78 patients (75.0 per cent) and by resection in 24 (23.1 per cent). Management of purulent peritonitis generally involved Hartmann's procedure (62 per cent) or resection and primary anastomosis (15 per cent). Similarly, patients with pericolic abscess usually underwent Hartmann's procedure (38 per cent) or resection and primary anastomosis (35 per cent). The principal operation for faecal peritonitis was Hartmann's resection (83 per cent). Large bowel obstruction was managed conservatively in four patients (13 per cent), by Hartmann's procedure in nine (29 per cent), and by resection and primary anastomosis with or without a proximal stoma in 13 (42 per cent). Most patients (82 per cent) with fistula associated with an abscess were managed by resection and primary anastomosis; 90 per cent with acute gastrointestinal bleeding were treated without operation.
1985年至1988年间，来自30家医院的300例复杂性憩室病患者的详细资料被纳入由外科研究协会组织的一项全国性审计。入院时存在的并发症包括急性蜂窝织炎（n = 104）、结肠周围脓肿（n = 34）、化脓性腹膜炎（n = 40）、大肠梗阻（n = 31）、粪性腹膜炎（n = 23）、合并瘘管的结肠周围脓肿（n = 28）和下消化道出血（n = 40）。总死亡率为11.3%（急性蜂窝织炎，4%；化脓性腹膜炎，27%；结肠周围脓肿，12%；粪性腹膜炎，48%；大肠梗阻，6%；出血，2%；瘘管，4%）。78例（75.0%）急性蜂窝织炎患者未进行手术治疗，24例（23.1%）接受了切除术。化脓性腹膜炎的治疗通常采用哈特曼手术（62%）或切除及一期吻合术（15%）。同样，结肠周围脓肿患者通常接受哈特曼手术（38%）或切除及一期吻合术（35%）。粪性腹膜炎的主要手术方式是哈特曼切除术（83%）。4例（13%）大肠梗阻患者采用保守治疗，9例（29%）采用哈特曼手术，13例（42%）采用切除及一期吻合术，部分患者有或无近端造口。大多数合并脓肿的瘘管患者（82%）采用切除及一期吻合术治疗；90%的急性胃肠道出血患者未进行手术治疗。
