Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A30, Cleveland, OH 44195, USA.
World J Gastroenterol. 2010 Feb 21;16(7):804-17. doi: 10.3748/wjg.v16.i7.804.
Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden. This review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical presentations. Wide-spectrum antibiotics are the standard of care for uncomplicated diverticulitis. Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended. Rather, a more individualized approach, taking into account frequency, severity of the attacks and their impact on quality of life, should guide the indication for surgery. On the other hand, complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal perforation. Laparoscopic surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized peritonitis. There is not sufficient evidence supporting any changes in the approach to management in younger patients. Conversely, the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals. Uncommon clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.
乙状结肠憩室炎是一种常见疾病，具有显著的发病率和社会经济负担。本文分析了目前关于乙状结肠憩室炎在不同临床表现下的治疗数据。广谱抗生素是单纯性憩室炎的标准治疗方法。最近发表的数据表明，与以前建议的那样，在第二次单纯性疾病发作后，乙状结肠憩室炎并不一定需要手术治疗。相反，应根据发作的频率、严重程度及其对生活质量的影响，采取更个体化的方法来指导手术指征。另一方面，对于可接受合并症风险的患者，复杂的憩室疾病仍需要手术治疗，并且在发生游离性腹膜穿孔的情况下仍然是危及生命的情况。腹腔镜手术越来越被接受为大多数疾病表现的首选手术方法，也被提议用于治疗弥漫性腹膜炎。目前尚无足够的证据支持对年轻患者的治疗方法进行任何改变。相反，现有证据表明，对于免疫功能低下的患者，在单纯性疾病发作一次后应进行手术。本文还讨论了乙状结肠憩室炎的罕见临床表现及其与炎症性肠病的可能关联。
