- 期刊
Diverting Stoma for Acute Perforated Diverticulitis with Purulent or Fecal Peritonitis: A Single-Center Experience
以糞便改道造口手術治療急性穿孔性憩室炎：單一醫學中心治療經驗
摘要
Purpose. The main approach to acute perforated diverticulitis with purulent or fecal peritonitis involves urgent open colectomy with colostomy. The aim of this study is to assess the feasibility of diverting stoma without resecting the diseased colon during acute perforated diverticulitis (Hinchey grade III or IV). Methods. Patients who received surgery for acute perforated diverticulitis (Hinchey grade III and IV) from 2014 to 2017 in our hospital were analyzed. This is a retrospective chart review study. We divided the patients into two groups according to surgical interventions: diverting stoma without resection of diseased colon or Hartmann's procedure. We review the patient demographics and short-term surgical outcomes. Results. The patient characteristics were similar in the two groups. The duration of surgery was shorter in diverting stoma group (mean 84.4 min) than that in the Hartmann's procedure group (mean 150.4 min) (p = 0.001). Patients receiving diverting stoma had less frequent postoperative ICU requirement and lower postoperative complication rate (15% in diverting stoma group; 50% in Hartmann's group). There were no significant intergroup differences in in-hospital mortality rate (two in diverting stoma group; zero in Hartmann's group), mean postoperative hospital stay and stoma reversal rate (53.3% in diverting stoma group; 50% in Hartmann's group). Conclusions. Diverting stoma without resecting the diseased colon is feasible and may benefit certain patients with acute perforated diverticulitis (Hinchey grade III or IV).
並列摘要
目的：治療急性穿孔性憩室炎的主要方法常需要緊急開放性結腸切除手術及造口術。本研究的目的是評估未切除結腸之糞便改道造口手術用於治療急性穿孔性憩室炎（Hinchey III和IV）的可行性。方法：對2014年至2017年在本院接受急性穿孔性憩室炎（Hinchey III和IV）手術的病患進行分析。這是一項回顧性研究。我們根據手術方式將病患分為兩組：未切除結腸之糞便改道造口手術或Hartmann手術。我們收集分析了病患的基本術前資料和短期手術結果。結果：這兩組病患的基本術前資料相近。糞便改道造口手術組的手術時間（平均84.4分鐘）短於Hartmann手術組（平均150.4分鐘）（p=0.001）。糞便改道造口手術組的病患術後加護病房照顧的需求較少，術後併發症發生率較低。院內死亡率，術後住院時間和造口閉合率則無顯著差異。結論：未切除結腸之糞便改道造口手術在急性穿孔性憩室炎病患是可行的，並且可以讓部份此類病患受益。
參考文獻
延伸閱讀
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