为了确定是否术前因素,如年龄,合并症,美国麻醉医师协会(ASA)分类,体重指数(BMI),腹膜炎的严重程度会影响进行原发性吻合术(PA)或Hartmann手术(HP)治疗穿孔憩室炎的患者的发病率和死亡率。这是一个系统的回顾和荟萃分析,根据PRISMA的说法,通过对PubMed的电子搜索,Medline,科克伦图书馆,和谷歌学者数据库。搜索检索了614项研究,其中包括11个。术前-术中因素,包括年龄,ASA分类,BMI,腹膜炎的严重程度,并收集了合并症。主要终点是死亡率和术后并发症,包括脓毒症,手术部位感染,伤口裂开,出血,术后肠梗阻,造口并发症,吻合口漏,和树桩泄漏。包括133,304名患者,其中126,504人(94.9%)接受了HP,6800人(5.1%)接受了PA。两组在合并症方面没有差异(p=0.32),BMI(p=0.28),或腹膜炎的严重程度(p=0.09)。死亡率无差异[RR0.76(0.44-1.33);p=0.33];[RR0.66(0.33-1.35);p=0.25]。HP组术后非手术并发症较多(p=0.02)。HP组腹膜炎的严重程度与死亡率之间存在显着关联(p=0.01),和手术部位感染(p=0.01)。在穿孔憩室炎患者中,可以选择PA。年龄,合并症,BMI不影响术后结局。腹膜炎的严重程度应作为术后发病率和死亡率的预测指标。
To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic
review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.