Floch Craig L
Fairfield County Bariatrics and Surgical Specialists, Norwalk, CT 06851 USA.
J Clin Gastroenterol. 2008 Nov-Dec;42(10):1152-3. doi: 10.1097/MCG.0b013e3181893648.
The scientific evidence and basis for standardized treatment for diverticulitis has been questioned. For years, medical and surgical management of acute diverticulitis included the theory that more than 2 significant attacks of diverticulitis would lead to the recommendations of surgical resection. This should be questioned and further investigated with prospective randomized trials. Only a small number of well-published articles support the surgical management with good scientific data. Although our ability to take a history and skill of physical examination has not changed, the use of improved technology such as high-speed computerized axial tomography has afforded us the ability to make earlier and more accurate diagnoses. This may further allow us to standardize treatment and study outcomes. It is possible that only the most critical situations may necessitate an operation. The age group less than 40 years, the immunocompromised, steroid-dependent, diabetic, and transplant patients, seem to be at greater risk with increased morbidity if not treated early and aggressively. Those individuals who present with perforation or compromised obstruction most likely will continue to need emergent intervention. But we need to reevaluate who needs surgical intervention while remaining within the confines of excellent and cost-effective care.
憩室炎标准化治疗的科学证据和依据受到了质疑。多年来，急性憩室炎的内科和外科治疗都包含这样一种理论，即超过2次严重的憩室炎发作会导致建议进行手术切除。这一点应受到质疑，并通过前瞻性随机试验进行进一步研究。只有少数发表充分的文章以良好的科学数据支持手术治疗。虽然我们问诊的能力和体格检查的技能没有改变，但诸如高速计算机断层扫描等改进技术的应用，使我们有能力做出更早、更准确的诊断。这可能会进一步使我们能够规范治疗并研究结果。有可能只有最危急的情况才需要进行手术。年龄小于40岁的人群、免疫功能低下者、依赖类固醇者、糖尿病患者以及移植患者，如果不及早进行积极治疗，似乎患病风险更高，发病率也会增加。那些出现穿孔或严重梗阻的患者很可能仍需要紧急干预。但我们需要重新评估哪些人需要手术干预，同时要保持在优质且具有成本效益的医疗范围内。
