Ambrosetti P, Robert J, Witzig J A, Mirescu D, de Gautard R, Borst F, Meyer P, Rohner A
Clinic of Digestive Surgery, University Hospital, Geneva, Switzerland.
Br J Surg. 1992 Feb;79(2):117-9. doi: 10.1002/bjs.1800790208.
This prospective study examined factors which may predict a poor outcome (complications and recurrence) after a first attack of diverticulitis which has been successfully managed conservatively. Twenty-four of 107 patients who entered the study had a poor outcome: persistent diverticulitis (nine cases), recurrence (seven cases), colonic stenosis (six cases), residual parasigmoid abscess (one case) and colovesical fistula (one case). Eight of the 18 men aged 50 years or less had a poor outcome compared with 16 of the remaining 89 patients (P = 0.032). Twelve of 76 patients (16 per cent) with mild findings on computed tomography (CT) (localized thickening of colonic wall and inflammation of pericolic fat) had a poor outcome compared with 11 of 23 patients (48 per cent) whose CT was estimated as severe (abscess and/or extraluminal air and/or extraluminal Gastrografin) (P = 0.004). These results suggest that elective colectomy can be proposed after a first attack of acute left diverticulitis in men up to 50 years of age and/or in patients whose initial CT reveals findings of severe diverticulitis.
这项前瞻性研究调查了在首次憩室炎发作经保守治疗成功控制后，可能预示不良预后（并发症和复发）的因素。107名进入该研究的患者中，有24例预后不良：持续性憩室炎（9例）、复发（7例）、结肠狭窄（6例）、乙状结肠旁残余脓肿（1例）和结肠膀胱瘘（1例）。18名50岁及以下男性中有8例预后不良，而其余89名患者中有16例预后不良（P = 0.032）。计算机断层扫描（CT）表现为轻度（结肠壁局限性增厚和结肠周围脂肪炎症）的76例患者中有12例（16%）预后不良，而CT表现估计为重度（脓肿和/或腔外气体和/或腔外泛影葡胺）的23例患者中有11例（48%）预后不良（P = 0.004）。这些结果表明，对于50岁及以下的男性和/或初始CT显示重度憩室炎表现的患者，在首次急性左半结肠憩室炎发作后可考虑行择期结肠切除术。
