Lorimer John W, Doumit Gaby
Department of Surgery, University of Ottawa, Room K-11, Ottawa Hospital/General Site, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6.
Am J Surg. 2007 Jun;193(6):681-5. doi: 10.1016/j.amjsurg.2006.10.019.
Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications.
A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity).
In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001).
There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.
急性结肠憩室炎可能是单纯性的，也可能是非常复杂的。关于哪些因素决定其严重程度，目前了解不多。回答这个问题可能具有治疗意义。
进行了一项回顾性研究，纳入教学医院收治的单纯性或复杂性急性憩室炎患者。目的是确定两组患者的特征及差异。采用查尔森指数评估既往健康状况（合并症）。
在多变量分析中，严重合并症（查尔森评分3分或更高）的存在与复杂性疾病密切相关（P = 0.02），使用非甾体类抗炎药也是如此（P = 0.01）。50岁以下患者未见死亡病例，高查尔森评分也强烈预示着死亡率（P < 0.0001）。
单纯性和复杂性憩室炎患者之间存在显著差异，合并症的程度（以查尔森评分衡量）似乎是一个主要因素。由于查尔森评分3分或更高且患有复杂性憩室炎的患者死亡率较高，我们认为对于这些患者，尤其是50岁及以上者，应考虑早期手术治疗。
