Department of Visceral Surgery University Hospital, Lausanne, Switzerland.
Dis Colon Rectum. 2010 Mar;53(3):333-8. doi: 10.1007/DCR.0b013e3181c3808c.
The severity and most appropriate treatment of diverticulitis in young patients are still controversial. The aim of this study is to compare young patients (<or=50 years) with older patients (>50 years) regarding clinical and radiologic parameters of acute left colonic diverticulitis and to determine whether differences exist in presentation and treatment.
We reviewed medical records of 271 consecutive patients with left colonic acute diverticulitis admitted to our institution from 2001 through 2004: 71 patients were aged 50 years or younger and 200 patients were older than 50. Clinical and radiologic parameters were analyzed. Conservative treatment was standardized, and included antibiotic therapy and bowel rest. Criteria for emergency surgical treatment were diffuse peritonitis, pneumoperitoneum, and septic shock.
Conservative treatment alone was successful in 64 patients (90.1%) in the younger group and in 152 patients (76%) in the older group (P = .017). The percentage of patients requiring surgery at admission or during the hospital stay was significantly lower in younger than in older patients (5.6% vs 20.5%, P = .007), and the percentage of patients requiring emergency end colostomy was higher (although not significantly) in the older group (1.4% vs 9.0%, P = .059). No differences in rate of successful conservative treatment were observed between patients with a first episode and those with recurrence in either age group (P = .941 in the younger group; P = .227 in the older group).
Young age is not a predictive factor of poor outcome in the management of first or recurrent episodes of acute diverticulitis. Patients older than 50 years more frequently need emergency surgical treatment.
年轻患者憩室炎的严重程度和最恰当的治疗方法仍存在争议。本研究旨在比较年轻患者（<或=50 岁）和老年患者（>50 岁）急性左结肠憩室炎的临床和影像学参数，并确定在表现和治疗方面是否存在差异。
我们回顾性分析了 2001 年至 2004 年期间我院收治的 271 例左结肠急性憩室炎患者的病历：71 例患者年龄在 50 岁或以下，200 例患者年龄大于 50 岁。分析了临床和影像学参数。保守治疗标准化，包括抗生素治疗和肠道休息。急诊手术治疗的标准为弥漫性腹膜炎、气腹和感染性休克。
年轻组中，64 例（90.1%）患者单独接受保守治疗成功，老年组中 152 例（76%）患者单独接受保守治疗成功（P =.017）。年轻组中需要入院或住院期间手术的患者比例明显低于老年组（5.6%比 20.5%，P =.007），需要紧急结肠造口术的患者比例较高（尽管无统计学意义）（老年组 1.4%比 9.0%，P =.059）。在两个年龄组中，首次发作和复发的患者保守治疗成功率均无差异（年轻组 P =.941；老年组 P =.227）。
年轻不是治疗首次或复发性急性憩室炎的不良预后的预测因素。年龄大于 50 岁的患者更常需要紧急手术治疗。
