Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Dis Colon Rectum. 2011 Jun;54(6):663-71. doi: 10.1007/DCR.0b013e31820ef759.
The surgical management of acute complicated diverticulitis has evolved to avoid emergency surgery in favor of elective resection. The optimal manner to accomplish this goal remains debatable.
The purpose of this study was to examine the efficacy of nonoperative management of acute diverticulitis with abscess or perforation.
A retrospective review was performed of an institutional review board-approved database of patients admitted with a diagnosis of acute complicated diverticulitis from 1995 to 2008. Patient demographics, disease manifestation, management, and outcomes were collected.
This study was conducted at a tertiary care hospital/referral center.
Patients were included who presented with complicated diverticulitis defined as having an associated abscess or free air diagnosed by CT scan.
Primary end points were the success of nonoperative management and need for surgery during the initial admission.
One hundred thirty-six patients were identified with perforated diverticulitis: 19 had localized free air, 45 had abscess <4 cm or distant free air measuring <2 cm, 66 had abscess >4 cm or distant free air >2 cm, and 6 had distant free air with free fluid. Thirty-eight patients (28%) required percutaneous abscess drains and 37 (27%) required parenteral nutrition. Only 5 patients (3.7%) required urgent surgery at the time of admission, and 7 (5%) required urgent surgery for failed nonoperative management. Thus, the overall success rate of nonoperative management was 91%. One hundred twenty-four of 131 (95%) patients were treated with nonoperative management successfully. Twenty-five of 27 (92.5%) patients with free air remote from the perforation site were successfully treated nonoperatively.
Nonoperative management of acute complicated diverticulitis is highly effective. For patients with free air remote from the site of perforation, nonoperative management is able to convert an emergent situation into an elective one in 93% of cases. The decision to attempt nonoperative therapy must be made based on the patient's physiologic state and associated comorbidities.
急性复杂憩室炎的手术治疗已经演变为避免急诊手术，转而采用择期切除。实现这一目标的最佳方式仍存在争议。
本研究旨在探讨伴有脓肿或穿孔的急性憩室炎非手术治疗的疗效。
回顾性分析了 1995 年至 2008 年期间因急性复杂憩室炎入院的经机构审查委员会批准的数据库。收集了患者的人口统计学、疾病表现、治疗和结局。
本研究在一家三级保健医院/转诊中心进行。
纳入的患者符合复杂憩室炎的诊断标准，即 CT 扫描诊断为伴有相关脓肿或游离气体。
主要终点是初始入院时非手术治疗的成功率和手术需求。
共确定 136 例穿孔性憩室炎患者：19 例有局限性游离气体，45 例有直径<4cm 的脓肿或<2cm 的远处游离气体，66 例有直径>4cm 的脓肿或>2cm 的远处游离气体，6 例有远处游离气体合并游离液体。38 例（28%）患者需要经皮脓肿引流，37 例（27%）患者需要肠外营养。仅 5 例（3.7%）患者在入院时需要紧急手术，7 例（5%）患者因非手术治疗失败需要紧急手术。因此，非手术治疗的总体成功率为 91%。131 例患者中，124 例（95%）成功接受非手术治疗。27 例游离气体远离穿孔部位的患者中，25 例（92.5%）成功接受非手术治疗。
急性复杂憩室炎的非手术治疗非常有效。对于游离气体远离穿孔部位的患者，非手术治疗能够将紧急情况转变为 93%的择期情况。是否尝试非手术治疗的决定必须基于患者的生理状态和相关合并症。
