PDF(Pubmed)
Abstract：
The management of perforated non-faeculent diverticulitis has traditionally involved performing a colonic resection (CR). Laparoscopic lavage (LL) has emerged as a less invasive alternative in recent years. The aim of this meta-analysis was to assess the role of LL in the surgical treatment of perforated non-faeculent diverticulitis. To that end, we conducted a search on Embase, Medline, and Cochrane databases for comparative studies in the English language published till June 2021 [PROSPERO (CRD42021269410)]. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2) and the methodological index for non-randomised studies (MINORS). Data were analysed using Cochrane RevMan. Pooled odds ratio (POR) and cumulative weighted ratios (CWR) were calculated. A total of 13 studies involving 1061 patients were found eligible, including seven studies based on three randomised control trials (RCTs). LL was associated with a reduced risk of wound infection, stoma formation, and need for further surgery by 77% [POR: 0.23, 95% confidence interval (CI): 0.07-0.74], 83% (POR: 0.17, 95% CI: 0.05-0.56), and 53% (POR: 0.47, 95% CI: 0.23-0.97) respectively. Duration of surgery and hospitalisation was reduced by 54% and 43% respectively. However, LL was associated with higher rates of unplanned reoperations (POR: 2.05, 95% CI: 1.22-3.42), recurrence (POR: 9.47, 95% CI: 3.24-27.67), and peritonitis (POR: 8.92, 95% CI: 2.71-29.33). No differences in mortality or readmission rates were observed. LL in Hinchey III diverticulitis lowers the incidence of stoma formation and overall reoperations without an increase in mortality but at the cost of higher recurrence rates and peritonitis. A limitation of this study was the inclusion of non-RCTs. An elective resection should be considered after LL. Guidelines for surgical techniques in LL need to be standardised.
摘要：
传统上，穿孔性非脓性憩室炎的治疗涉及结肠切除术（CR）。近年来，腹腔镜灌洗（LL）已成为一种侵入性较小的替代方法。这项荟萃分析的目的是评估LL在穿孔性非脓性憩室炎的手术治疗中的作用。为此,我们在Embase进行了搜索,Medline,和Cochrane数据库的英语比较研究发布至2021年6月[PROSPERO(CRD42021269410)]。使用修订后的Cochrane用于随机试验的偏倚风险工具（RoB2）和非随机研究的方法学指数（MINORS）评估偏倚风险。使用CochraneRevMan分析数据。计算汇总比值比(POR)和累积加权比(CWR)。共有13项研究符合资格，涉及1061名患者，包括基于三项随机对照试验（RCTs）的七项研究。LL与伤口感染风险降低有关，造口形成,并且需要进一步手术77％[POR：0.23，95％置信区间（CI）：0.07-0.74]，83%（POR：0.17，95%CI：0.05-0.56），53%(POR:0.47,95%CI:0.23-0.97)。手术和住院时间分别减少了54%和43%。然而,LL与较高的计划外再手术率相关(POR：2.05，95%CI：1.22-3.42)，复发（POR：9.47，95%CI：3.24-27.67），和腹膜炎（POR：8.92，95％CI：2.71-29.33）。没有观察到死亡率或再入院率的差异。HincheyIII憩室炎的LL降低了造口形成和整体再手术的发生率，而没有增加死亡率，但以更高的复发率和腹膜炎为代价。这项研究的局限性在于纳入了非随机对照试验。LL后应考虑进行选择性切除。LL的外科技术指南需要标准化。
