Department of Visceral Surgery, University Hospital CHUV, Lausanne, CH-1011, Switzerland.
World J Surg. 2009 Mar;33(3):547-52. doi: 10.1007/s00268-008-9898-9.
Until recently, it was accepted that the rate of complications and failure of medical therapy were higher during recurrent episodes of diverticulitis. New data and new interpretation of older studies have challenged this opinion. The aim of the present study was to determine whether recurrent diverticulitis in comparison with the initial episode has a different short-term outcome after medical or surgical treatment.
This was a retrospective cohort study of 271 consecutive patients admitted for diverticulitis confirmed by computed tomography (CT) between 2001 and 2004. Altogether 202 patients had an initial episode (group I), and 69 had recurrent diverticulitis (group R). A total of 20 clinical and 15 radiologic parameters were analyzed and compared between the two groups, including need for surgery, clinical presentation at admission, response to treatment, complications, laboratory parameters, and pathologic CT features (colonic wall thickening, abscess, pneumoperitoneum, free intraperitoneal fluid). An unpaired Student's t-test and Fisher's and Wilcoxon's tests were applied for statistical analysis.
None of the clinical or radiologic parameters was statistically different between the two groups. Regarding surgery, 15.8% of the group I patients needed surgery at admission compared to 5.8% in group R (p = 0.04). Conservative treatment failure was similar in the two groups (10.7% vs. 10.0%; p = 0.84). There was 3% mortality at 30 days in group I compared to 0% in group R.
Recurrent episodes of diverticulitis do not lead to more complications and more conservative treatment failure. Moreover, surgery at admission was less frequent among patients who presented with a recurrence.
直到最近，人们还认为在憩室炎反复发作时，并发症和药物治疗失败的发生率更高。新的数据和对旧研究的新解释对这一观点提出了挑战。本研究的目的是确定与初次发作相比，复发性憩室炎在接受药物或手术治疗后的短期结果是否不同。
这是一项回顾性队列研究，纳入了 2001 年至 2004 年间经计算机断层扫描（CT）确诊为憩室炎的 271 例连续患者。共有 202 例患者为初次发作（I 组），69 例为复发性憩室炎（R 组）。对两组患者共 20 个临床和 15 个影像学参数进行分析和比较，包括手术需求、入院时的临床表现、治疗反应、并发症、实验室参数和病理 CT 特征（结肠壁增厚、脓肿、气腹、游离腹腔积液）。应用非配对学生 t 检验和 Fisher 检验和 Wilcoxon 检验进行统计学分析。
两组间无任何临床或影像学参数存在统计学差异。在手术方面，I 组有 15.8%的患者在入院时需要手术，而 R 组为 5.8%（p=0.04）。两组的保守治疗失败率相似（10.7% vs. 10.0%；p=0.84）。I 组有 3%的患者在 30 天时死亡，而 R 组为 0%。
复发性憩室炎不会导致更多的并发症和更多的保守治疗失败。此外，在出现复发的患者中，入院时进行手术的比例较低。
