Peppas George, Bliziotis Ioannis A, Oikonomaki Dora, Falagas Matthew E
Alfa Institute of Biomedical Sciences (AIBS), and Department of Surgery, Henry Dunant Hospital, Athens, Greece.
J Gastroenterol Hepatol. 2007 Sep;22(9):1360-8. doi: 10.1111/j.1440-1746.2007.05118.x.
There is still controversy regarding the appropriate management of diverticulitis of the colon in cases when both surgical and conservative treatment may be an option. We performed a systematic review of the available evidence regarding the outcomes after medical and surgical treatment of diverticulitis from studies published after 1980 and indexed in the PubMed database. We included original studies that reported comparative data for at least one outcome in medically- and surgically-treated patients with transverse or left colon diverticulitis. The main outcomes of interest were mortality, morbidity, and recurrence of diverticulitis after medical or surgical treatment. There were 21 studies fulfilling our inclusion criteria out of 1360 initially identified as possibly relevant. More patients were treated conservatively in the included studies compared to emergency surgery (24 862 vs 6504). Emergency surgery was the main option for patients with severe complications of diverticular disease, including peritonitis. In most studies, in-hospital mortality for patients treated surgically was generally higher than that of patients treated medically, whereas there were insufficient comparative data regarding mortality during follow up. However, readmission to the hospital due to diverticular disease during follow up was more common in the group of patients treated conservatively compared to those treated surgically (4358/23 446 [18.6%]vs 22/359 [6.1%]). Conservatively-treated patients, with a first or second episode of diverticulitis, required surgery for recurrent disease during follow up in a maximum of 45% of cases, with larger studies reporting percentages lower than 11%. It should be emphasized that medical and surgical treatments have not ever been compared in a randomized controlled trial in patients with diverticulitis (without generalized peritonitis that is a surgical emergency). Although medical treatment results in more readmissions due to recurrence, it may be reasonable to avoid surgical therapy in the vast majority of patients with acute diverticulitis. It is unclear what the best treatment option is for younger patients (<50 years), namely whether elective surgery should be considered with the first episode of diverticulitis.
对于结肠憩室炎在手术治疗和保守治疗都可行的情况下，如何进行恰当处理仍存在争议。我们对1980年后发表并被PubMed数据库收录的研究中关于憩室炎药物治疗和手术治疗后的结果的现有证据进行了系统评价。我们纳入了报告了横结肠或左结肠憩室炎患者药物治疗和手术治疗至少一项结果的比较数据的原始研究。主要关注的结果是药物或手术治疗后的死亡率、发病率和憩室炎复发率。在最初确定可能相关的1360项研究中，有21项符合我们的纳入标准。与急诊手术相比，纳入研究中接受保守治疗的患者更多（24862例对6504例）。急诊手术是憩室病严重并发症患者（包括腹膜炎患者）的主要选择。在大多数研究中，手术治疗患者的院内死亡率通常高于药物治疗患者，而关于随访期间死亡率的比较数据不足。然而，与手术治疗的患者相比，保守治疗的患者在随访期间因憩室病再次入院更为常见（4358/23446[18.6%]对22/359[6.1%]）。首次或第二次发作憩室炎的保守治疗患者，在随访期间因复发性疾病需要手术治疗的病例最多占45%，大型研究报告的比例低于11%。应该强调的是，对于憩室炎患者（无作为外科急症表现的弥漫性腹膜炎），药物治疗和手术治疗从未在随机对照试验中进行过比较。虽然药物治疗因复发导致更多患者再次入院，但在绝大多数急性憩室炎患者中避免手术治疗可能是合理的。对于年轻患者（<50岁），最佳治疗选择尚不清楚，即首次发作憩室炎时是否应考虑择期手术。
