评估单纯性憩室炎复发和并发症。

Assessment of recurrence and complications following uncomplicated diverticulitis.

机构信息

Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland.

出版信息

Br J Surg. 2013 Jun;100(7):976-9; discussion 979. doi: 10.1002/bjs.9119. Epub 2013 Apr 17.

DOI:10.1002/bjs.9119

PMID:23592303

Abstract

BACKGROUND

The natural history of sigmoid diverticulitis has been inferred from population-based or retrospective studies. This study assessed the risk of a recurrent attack following the first episode of uncomplicated diverticulitis.

METHODS

Patients admitted between January 2007 and December 2011 with a first episode of uncomplicated sigmoid diverticulitis confirmed on computed tomography were enrolled in this prospective study. After successful medical management of the first episode, follow-up was conducted through yearly telephone interviews. Cox proportional hazards regression was performed to model the impact of various parameters on eventual recurrences and complications.

RESULTS

During a median follow-up of 24 (range 3-63) months, 46 (16·4 per cent) of 280 patients experienced a second episode of diverticulitis. Six patients (2·1 per cent) subsequently developed complicated diverticulitis and four (1·4 per cent) underwent emergency surgery for peritonitis. In multivariable analysis, a raised serum level of C-reactive protein (over 240 mg/l) during the first attack was associated with early recurrence (hazard ratio 1·75, 95 per cent confidence interval 1·04 to 2·94; P = 0·035).

CONCLUSION

Uncomplicated sigmoid diverticulitis follows a benign course with few recurrences and little need for emergency surgery.

REGISTRATION NUMBER

NCT01015378 (http://www.clinicaltrials.gov).

摘要

背景

乙状结肠憩室炎的自然病程是从基于人群或回顾性研究中推断出来的。本研究评估了首次单纯性憩室炎发作后再次发作的风险。

方法

本前瞻性研究纳入了 2007 年 1 月至 2011 年 12 月期间因首次确诊的单纯性乙状结肠憩室炎而入院的患者。在首次发作经药物治疗成功后，通过每年的电话访谈进行随访。采用 Cox 比例风险回归模型分析各种参数对最终复发和并发症的影响。

结果

在中位随访 24（范围 3-63）个月期间，280 例患者中有 46 例（16.4%）经历了第二次憩室炎发作。6 例患者（2.1%）随后发展为复杂性憩室炎，4 例（1.4%）因腹膜炎行急诊手术。多变量分析显示，首次发作时血清 C 反应蛋白升高（超过 240mg/l）与早期复发相关（风险比 1.75，95%置信区间 1.04-2.94；P=0.035）。