Ibele Anna, Heise Charles P
Charles P. Heise, MD G4/701A Clinical Sciences Center, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792-7375, USA.
Curr Treat Options Gastroenterol. 2007 Jun;10(3):248-56. doi: 10.1007/s11938-007-0018-y.
Diverticular disease is an extremely common disease entity in our society. The major complication of diverticular disease, diverticulitis, can have quite variable presentations. In the acute setting, treatment is divided into nonsurgical (conservative) or surgical therapy. Cases of mild or "uncomplicated" disease benefit from a conservative approach involving antibiotic therapy. With more severe or "complicated" presentations (abscess, phlegmon, obstruction, fistula, or peritonitis), a more aggressive approach may involve percutaneous abscess drainage or urgent surgical therapy. This also may be required after a failed initial attempt at medical management. The decision regarding elective surgery after successful medical management of diverticulitis is more complicated. The primary goal is to minimize disease recurrence with as little morbidity as possible while maintaining a high quality of life. Recent evidence challenges indications for elective surgery. However, data on the natural history of recurrent diverticulitis are not clear enough to support altering current surgical guidelines. In addition, the increasing use of minimally invasive techniques with favorable outcomes for sigmoid colectomy must be considered. Prior to offering elective colectomy for diverticulitis, it remains important to individualize each case, giving special consideration to age, symptomatology, and recurrence. Ultimately, the decision for elective surgery is made by both the surgeon and a well-informed patient.
憩室病在我们的社会中是一种极为常见的疾病实体。憩室病的主要并发症——憩室炎，其表现形式可能相当多样。在急性期，治疗分为非手术（保守）治疗或手术治疗。轻度或“非复杂性”疾病的病例可通过包括抗生素治疗在内的保守方法获益。对于更严重或“复杂性”表现（脓肿、蜂窝织炎、梗阻、瘘管或腹膜炎），更积极的方法可能包括经皮脓肿引流或紧急手术治疗。在初始药物治疗尝试失败后也可能需要这样做。憩室炎经成功药物治疗后关于择期手术的决策更为复杂。主要目标是以尽可能低的发病率将疾病复发风险降至最低，同时维持较高的生活质量。近期证据对择期手术的指征提出了质疑。然而，关于复发性憩室炎自然病程的数据尚不够明确，不足以支持改变当前的手术指南。此外，必须考虑到微创技术在乙状结肠切除术中的应用日益增加且效果良好。在为憩室炎提供择期结肠切除术之前，对每个病例进行个体化处理仍然很重要，要特别考虑年龄、症状和复发情况。最终，择期手术的决策由外科医生和充分知情的患者共同做出。
