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Abstract：
OBJECTIVE: The management of perforated diverticulitis with generalized peritonitis is still controversial and no preferred standardized therapeutic approach has been determined. We compared surgical outcomes between Hartmann\'s procedure (HP) and primary anastomosis (PA) in patients with Hinchey III and IV perforated diverticulitis.
METHODS: Multicenter retrospective analysis of 131 consecutive patients with Hinchey III and IV diverticulitis operated either with HP or PA from 2015 to 2018. Postoperative morbidity was compared after adjustment for known risk factors in a multivariate logistic regression.
RESULTS: Sixty-six patients underwent HP, while PA was carried out in 65 patients, 35.8% of those were defunctioned. HP was more performed in older patients (74.6 vs. 61.2 years, p < .001), with Hinchey IV diverticulitis (37% vs. 7%, p < .001) and in patients with worse prognostic scores (P-POSSUM Physiology Score, p < .001, Charlson Comorbidity Index p < .001). Major morbidity and mortality were higher in HP compared to PA (30.3% vs. 9.2%, p = .002 and 10.6% vs. 0%, p = .007, respectively) with lower stoma reversal rate (43.9% vs. 86.9%, p < .001). In a multivariate logistic regression, PA was independently associated with lower postoperative morbidity and mortality (OR 0.24, 95% CI 0.06-0.96, p = .044).
CONCLUSIONS: In comparison to PA, HP is associated with a higher morbidity, higher mortality, and a lower stoma reversal rate. Although a higher prevalence of risk factors in HP patients may explain these outcomes, a significant increase in morbidity and mortality persisted in a multivariate logistic regression analysis that was stratified for the identified risk factors.
METHODS: Multicenter retrospective analysis of 131 consecutive patients with Hinchey III and IV diverticulitis operated either with HP or PA from 2015 to 2018. Postoperative morbidity was compared after adjustment for known risk factors in a multivariate logistic regression.
RESULTS: Sixty-six patients underwent HP, while PA was carried out in 65 patients, 35.8% of those were defunctioned. HP was more performed in older patients (74.6 vs. 61.2 years, p < .001), with Hinchey IV diverticulitis (37% vs. 7%, p < .001) and in patients with worse prognostic scores (P-POSSUM Physiology Score, p < .001, Charlson Comorbidity Index p < .001). Major morbidity and mortality were higher in HP compared to PA (30.3% vs. 9.2%, p = .002 and 10.6% vs. 0%, p = .007, respectively) with lower stoma reversal rate (43.9% vs. 86.9%, p < .001). In a multivariate logistic regression, PA was independently associated with lower postoperative morbidity and mortality (OR 0.24, 95% CI 0.06-0.96, p = .044).
CONCLUSIONS: In comparison to PA, HP is associated with a higher morbidity, higher mortality, and a lower stoma reversal rate. Although a higher prevalence of risk factors in HP patients may explain these outcomes, a significant increase in morbidity and mortality persisted in a multivariate logistic regression analysis that was stratified for the identified risk factors.
摘要：
目的：穿孔憩室炎合并全身性腹膜炎的治疗仍存在争议，尚未确定首选的标准化治疗方法。我们比较了HincheyIII和IV穿孔憩室炎患者的Hartmann手术（HP）和原发性吻合术（PA）的手术结果。
方法：多中心回顾性分析了2015年至2018年使用HP或PA手术的131例连续HincheyIII和IV憩室炎患者。在多变量逻辑回归中校正已知的危险因素后，比较了术后发病率。
结果：66例患者接受HP，虽然在65名患者中进行了PA，35.8％的人被停职。HP在老年患者中更多（74.6vs.61.2年，p<.001),HincheyIV憩室炎（37%vs.7%,p<.001）和预后评分较差的患者（P-POSSUM生理学评分，p<.001，Charlson合并症指数p<.001)。与PA相比，HP的主要发病率和死亡率更高(30.3%vs.9.2%，p=.002和10.6%与0%,p=.007，分别为），气孔逆转率较低（43.9%与86.9%,p<.001)。在多元逻辑回归中，PA与较低的术后发病率和死亡率独立相关（OR0.24，95％CI0.06-0.96，p=0.044）。
结论：与PA相比，HP与较高的发病率相关，死亡率更高,和较低的气孔逆转率。尽管HP患者中更高的危险因素患病率可以解释这些结果，在对已确定的危险因素进行分层的多因素logistic回归分析中,发病率和死亡率显著升高.
方法：多中心回顾性分析了2015年至2018年使用HP或PA手术的131例连续HincheyIII和IV憩室炎患者。在多变量逻辑回归中校正已知的危险因素后，比较了术后发病率。
结果：66例患者接受HP，虽然在65名患者中进行了PA，35.8％的人被停职。HP在老年患者中更多（74.6vs.61.2年，p<.001),HincheyIV憩室炎（37%vs.7%,p<.001）和预后评分较差的患者（P-POSSUM生理学评分，p<.001，Charlson合并症指数p<.001)。与PA相比，HP的主要发病率和死亡率更高(30.3%vs.9.2%，p=.002和10.6%与0%,p=.007，分别为），气孔逆转率较低（43.9%与86.9%,p<.001)。在多元逻辑回归中，PA与较低的术后发病率和死亡率独立相关（OR0.24，95％CI0.06-0.96，p=0.044）。
结论：与PA相比，HP与较高的发病率相关，死亡率更高,和较低的气孔逆转率。尽管HP患者中更高的危险因素患病率可以解释这些结果，在对已确定的危险因素进行分层的多因素logistic回归分析中,发病率和死亡率显著升高.
