Martín Arévalo J, García-Granero E, García Botello S, Muñoz E, Cervera V, Flor Lorente B, Lledó S
Departamento de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Clínico de Valencia, Universidad de Valencia.
Rev Esp Enferm Dig. 2007 Jun;99(6):320-4. doi: 10.4321/s1130-01082007000600003.
To assess the early use of CT for the diagnosis, staging, and management of acute diverticulitis.
A prospective study of 102 patients with a clinical diagnosis of acute diverticulitis of the left colon. Acute diverticulitis was initially divided into 3 clinical stages. Patients were restaged according to CT findings into stages I, IIa, IIb, and III. Diagnosis was subsequently confirmed intraoperatively or by colonoscopy or barium studies.
102 patients (52 females and 50 males, mean age of 59.4 (SD + 14.96 years)) were included; 84 (82.35%) patients with a clinical diagnosis of acute diverticulitis were confirmed to suffer this disease for a diagnostic error of 17.65% (n=18). Acute diverticulitis was diagnosed by CT in 84.3% (n=86). CT had a sensitivity of 100% and a specificity of 88.9%. CT changed clinical stage for 38% of patients because of understaging in 13% and of overstaging in 25%. When stages II and III were analyzed separately, 60 and 50% were overstaged, respectively. The reclassification of patients according to CT results had a significant impact on treatment.
Early clinical staging with CT avoids diagnostic clinical errors in 17.65% of patients. CT changes the initial clinical staging of acute episodes in 38% of cases, thus avoiding unnecessary delays in surgery for severe cases, and unnecessary surgeries for mild cases.
评估CT在急性憩室炎诊断、分期及治疗中的早期应用。
对102例临床诊断为左半结肠急性憩室炎的患者进行前瞻性研究。急性憩室炎最初分为3个临床阶段。根据CT检查结果将患者重新分期为I期、IIa期、IIb期和III期。随后通过手术、结肠镜检查或钡剂造影检查确诊。
纳入102例患者（52例女性，50例男性，平均年龄59.4岁（标准差+14.96岁））；84例（82.35%）临床诊断为急性憩室炎的患者经确诊患有该病，诊断错误率为17.65%（n=18）。CT诊断急性憩室炎的准确率为84.3%（n=86）。CT的敏感性为100%，特异性为88.9%。CT使38%的患者临床分期发生改变，其中13%为分期过低，25%为分期过高。单独分析II期和III期时，分期过高的比例分别为60%和50%。根据CT结果对患者进行重新分类对治疗有显著影响。
CT早期临床分期可避免17.65%的患者出现诊断性临床错误。CT在38%的病例中改变了急性发作的初始临床分期，从而避免了重症患者手术的不必要延迟以及轻症患者的不必要手术。
