Andeweg Caroline, Peters Joost, Bleichrodt Robert, van Goor Harry
Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
World J Surg. 2008 Jul;32(7):1501-6. doi: 10.1007/s00268-008-9530-z.
Diverticular disease is a common problem in Western countries. Rationale for elective surgery is to prevent recurrent complicated diverticulitis and to reduce emergency procedures. Recurrent diverticulitis occurs in about 10% after resection. The pathogenesis for recurrence is not completely understood. We studied the incidence and risk factors for recurrence and the overall morbidity and mortality of surgical therapy for diverticular disease.
Medical records of 183 consecutive patients with pathology-proven diverticulitis were eligible for evaluation. Mean duration of follow-up was 7.2 years. Number of preoperative episodes, emergency or elective surgeries, type of operation, level of anastomosis, postoperative complications, persistent postoperative pain, complications associated with colostomy reversal, and recurrent diverticulitis were noted. The Kaplan-Meier method was used to calculate the cumulative probability of recurrence. Cox regression was used to identify possible risk factors for recurrence.
The incidence of recurrence was 8.7%, with an estimated risk of recurrence over a 15-year period of 16%. Risk factors associated with recurrence were (younger) age (p < 0.02) and the persistence of postoperative pain (p < 0.005). Persistent abdominal pain after surgery was present in 22%. Eighty percent of patients who needed emergency surgery for acute diverticulitis had no manifestation of diverticular disease prior to surgery. In addition, recurrent diverticulitis was not associated with a higher percentage of emergency procedures.
Estimated risk of recurrence is high and abdominal complaints after surgical therapy for diverticulitis are frequent. Younger age and persistence of postoperative symptoms predict recurrent diverticulitis after resection. The clinical implication of these findings needs further investigation. The results of this study support the careful selection of patients for surgery for diverticulitis.
憩室病在西方国家是一个常见问题。择期手术的理由是预防复发性复杂性憩室炎并减少急诊手术。切除术后复发性憩室炎的发生率约为10%。复发的发病机制尚未完全明确。我们研究了憩室病手术治疗的复发率、复发危险因素以及总体发病率和死亡率。
183例经病理证实为憩室炎的连续患者的病历符合评估条件。平均随访时间为7.2年。记录术前发作次数、急诊或择期手术、手术类型、吻合水平、术后并发症、术后持续疼痛、结肠造口回纳相关并发症以及复发性憩室炎。采用Kaplan-Meier法计算复发的累积概率。采用Cox回归确定复发的可能危险因素。
复发率为8.7%，估计15年期间的复发风险为16%。与复发相关的危险因素为（较年轻的）年龄（p<0.02）和术后疼痛持续存在（p<0.005）。22%的患者术后存在持续性腹痛。因急性憩室炎需要急诊手术的患者中，80%在手术前无憩室病表现。此外，复发性憩室炎与更高比例的急诊手术无关。
憩室炎手术治疗后的复发风险估计较高，且术后腹部不适很常见。较年轻的年龄和术后症状持续存在可预测切除术后复发性憩室炎。这些发现的临床意义需要进一步研究。本研究结果支持对憩室炎手术患者进行谨慎选择。
