Chen Chao-Yang, Wu Chang-Chieh, Jao Shu-Wen, Pai Lu, Hsiao Cheng-Wen
Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, 6F, No. 325, Sec. 2, Cheng- Kung Road, Nei-Hu 114, Taipei, Taiwan, Republic of China.
J Gastrointest Surg. 2009 Mar;13(3):516-20. doi: 10.1007/s11605-008-0731-4.
Colonic diverticular bleeding can usually be managed with conservative treatment. However, in a selected group of patients under conditions of recurrent, persistent bleeding influencing quality of life or causing life-threatening shock, it should be managed with surgery. This is a retrospective study to clarify the risk factors relating to colectomy for colonic diverticular bleeding.
Between 1997 and 2005, a retrospective chart review of 73 patients with colonic diverticular bleeding was undertaken. Univariate and multivariate logistic regression analyses were performed to identify the relevant risk factors correlating to colectomy.
The mean age of the 73 patients was 70 years (range, 22-90 years). Most colonic diverticular bleeding could be managed with conservative treatment (n = 63, 86.3%), and urgent colectomy was performed in ten patients (13.7%). The bleeding site could not be well identified in six of those ten patients and so underwent total abdominal colectomy with ileorectal anastomosis, and the other four underwent right hemicolectomy after a diagnosis of right-sided colon diverticula with bleeding. There were two deaths in the surgical group and one death in the nonsurgical group. The overall mortality rate in the series was 4.11% and 20% among patients undergoing urgent colectomy. Multiple logistic regression analysis showed that the presence of comorbidities and daily maximum blood transfusion requirement were risk factors for urgent colectomy for colonic diverticular bleeding.
Preoperative comorbid diseases may increase operative risk in urgent surgery, and the outcome is poor. To avoid high mortality and morbidity relating to the urgent colectomy, we suggest that patients of colonic diverticular bleeding with comorbid diseases, especially subgroups of patients with diabetes and gouty arthritis, may need early elective colectomy.
结肠憩室出血通常可采用保守治疗。然而，对于一部分反复持续性出血影响生活质量或导致危及生命的休克的特定患者，应进行手术治疗。本研究旨在回顾性分析结肠憩室出血行结肠切除术的相关危险因素。
回顾性分析1997年至2005年间73例结肠憩室出血患者的病历资料。采用单因素和多因素logistic回归分析确定与结肠切除术相关的危险因素。
73例患者的平均年龄为70岁（范围22 - 90岁）。大多数结肠憩室出血患者可通过保守治疗（n = 63，86.3%），10例患者（13.7%）行急诊结肠切除术。这10例患者中有6例出血部位难以明确，行全腹结肠切除回肠直肠吻合术，另外4例诊断为右侧结肠憩室出血后行右半结肠切除术。手术组死亡2例，非手术组死亡1例。该系列患者的总死亡率为4.11%，急诊结肠切除术患者的死亡率为20%。多因素logistic回归分析显示，合并症的存在和每日最大输血量需求是结肠憩室出血行急诊结肠切除术的危险因素。
术前合并症可能增加急诊手术的风险，且预后较差。为避免急诊结肠切除术相关的高死亡率和高发病率，我们建议合并症的结肠憩室出血患者，尤其是糖尿病和痛风性关节炎患者亚组，可能需要早期择期结肠切除术。
