Lane J S, Sarkar R, Schmit P J, Chandler C F, Thompson J E
Department of Surgery, UCLA School of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.
J Am Coll Surg. 1999 Jun;188(6):629-34; discussion 634-5. doi: 10.1016/s1072-7515(99)00043-5.
Cecal diverticulitis is a rare condition in the Western world, with a higher incidence in people of Asian descent. The treatment for cecal diverticulitis has ranged from expectant medical management, which is similar to uncomplicated left-sided diverticulitis, to right hemicolectomy.
A retrospective chart review was conducted of the 49 patients treated for cecal diverticulitis at Olive View-UCLA Medical Center from 1976 to 1998. This was the largest-ever single-institution review of cecal diverticulitis reported in the mainland US.
The clinical presentation was similar to that of acute appendicitis, with abdominal pain, low-grade fever, nausea/vomiting, abdominal tenderness, and leukocytosis. Operations performed included right hemicolectomy in 39 patients (80%), diverticulectomy in 7 patients (14%), and appendectomy with drainage of intraabdominal abscess in 3 patients (6%). Of the 7 patients who had diverticulectomy, 1 required right hemicolectomy at 6 months followup for continued symptoms. Of the three patients who underwent appendectomy with drainage, all required subsequent hemicolectomy for continued inflammation. Of the 39 patients who received immediate hemicolectomies, there were complications in 7 (18%), with no mortality.
We endorse an aggressive operative approach to the management of cecal diverticulitis, with the resection of all clinically apparent disease at the time of the initial operation. In cases of a solitary diverticulum, we recommend the use of diverticulectomy when it is technically feasible. When confronted with multiple diverticuli and cecal phlegmon, or when neoplastic disease cannot be excluded, we advocate immediate right hemicolectomy. This procedure can be safely performed in the unprepared colon with few complications. Excisional treatment for cecal diverticulitis prevents the recurrence of symptoms, which may be more common in the Western population.
盲肠憩室炎在西方世界是一种罕见疾病，在亚裔人群中发病率较高。盲肠憩室炎的治疗方法多样，从类似于非复杂性左侧憩室炎的保守药物治疗到右半结肠切除术。
对1976年至1998年在橄榄景 - 加州大学洛杉矶分校医学中心接受治疗的49例盲肠憩室炎患者进行了回顾性病历审查。这是美国大陆报道的有史以来最大规模的单机构盲肠憩室炎回顾研究。
临床表现与急性阑尾炎相似，包括腹痛、低热、恶心/呕吐、腹部压痛和白细胞增多。所实施的手术包括39例（80%）右半结肠切除术、7例（14%）憩室切除术以及3例（6%）阑尾切除并引流腹腔脓肿。在接受憩室切除术的7例患者中，1例在6个月随访时因症状持续而需要进行右半结肠切除术。在接受阑尾切除并引流的3例患者中，所有患者随后均因炎症持续而需要进行半结肠切除术。在接受即刻半结肠切除术的39例患者中，7例（18%）出现并发症，无死亡病例。
我们支持对盲肠憩室炎采取积极的手术治疗方法，在初次手术时切除所有临床可见的病变。对于单个憩室的病例，在技术可行时我们建议采用憩室切除术。当面对多个憩室和盲肠蜂窝织炎，或无法排除肿瘤性疾病时，我们主张立即进行右半结肠切除术。该手术可在未做准备的结肠中安全进行，并发症较少。对盲肠憩室炎进行切除治疗可防止症状复发，而症状复发在西方人群中可能更为常见。
