Schildberg C W, Schellerer V, Croner R, Oberländer H, Hohenberger W
Chirurgie, Universität Erlangen, Deutschland.
Zentralbl Chir. 2015 Dec;140(6):585-90. doi: 10.1055/s-0032-1328593. Epub 2013 Aug 1.
Pathological changes of preexisting sigma diverticulosis into a state of sigma diverticulitis are possible. Treatment of sigma diverticulitis accounts for a significant proportion of emergency treatments in clinics. The number of patients treated for sigma diverticulitis has risen steadily in recent years. Although it can be observed that operated cases making 7 % compared with 14 % to all stationary admissions, there is a less marked increase. Nevertheless, the question should be clarified as to how high the proportion of complicated surgical cases is in relation to non-complicated cases. It is important to clarify, in this context, if each operation is justified or whether in some cases there is over-treatment.
All data relating to Germany, were prospectively collected by the treating hospitals using the DRG and evaluated by the Federal Statistical Office. The treatment numbers from Erlangen were prospectively collected from the encrypted DRG and analysed retrospectively by the coding officer. The investigated period lasted from 2005 to 2010. To demonstrate some treatment options, the following possible forms of therapy were examined with reference to the Hansen/Stock classification.
In Germany, about 40 % of stationary patients with sigma diverticulitis are treated surgically. It is striking that in about two thirds of all operated patients uncomplicated forms of diverticulitis were present. The remainder consisted of covered or free perforations. For these complicated forms, various treatment approaches have been established. Ultimately, in dependence of timing these are always surgically treated. In the milder forms the general indication for surgery has come into discussion as the recommendation for a surgical approach after the second relapse in the symptom-free interval is being questioned by several groups based on the age of the studies on which the recommendations are based.
A significant increase in hospital admissions and surgically treated patients is demonstrated. Striking was that a closer analysis of data revealed that mainly non-complicated cases were surgically treated. This should be seen as a clear indication for an over-treatment. Therefore, possibly not all surgeries performed are justified. In the case of complicated forms, in consideration of various treatment paths, surgery is inevitable in most cases.
原有乙状结肠憩室病转变为乙状结肠憩室炎是有可能的。乙状结肠憩室炎的治疗在临床急诊治疗中占相当大的比例。近年来，接受乙状结肠憩室炎治疗的患者数量稳步上升。虽然可以观察到手术病例占所有住院病例的7%，而之前为14%，增长不太明显。然而，应明确复杂手术病例与非复杂病例的比例有多高。在这种情况下，重要的是要弄清楚每例手术是否合理，或者在某些情况下是否存在过度治疗。
所有与德国相关的数据均由治疗医院使用疾病诊断相关分组（DRG）进行前瞻性收集，并由联邦统计局进行评估。来自埃尔朗根的治疗数据从加密的DRG中前瞻性收集，并由编码人员进行回顾性分析。调查期从2005年持续到2010年。为了展示一些治疗选择，参考汉森/施托克分类法对以下可能的治疗形式进行了研究。
在德国，约40%的乙状结肠憩室炎住院患者接受了手术治疗。值得注意的是，在所有接受手术的患者中，约三分之二为非复杂性憩室炎。其余包括有覆盖的或游离的穿孔。对于这些复杂形式，已经确立了各种治疗方法。最终，根据时机不同，这些情况总是通过手术治疗。在较轻的形式中，手术的一般指征已成为讨论的话题，因为基于相关研究的年龄，一些研究小组对在无症状期第二次复发后推荐手术治疗的建议提出了质疑。
住院患者和接受手术治疗的患者数量显著增加。引人注目的是，对数据的进一步分析表明，接受手术治疗的主要是非复杂病例。这应被视为过度治疗的明确迹象。因此，可能并非所有进行的手术都是合理的。对于复杂形式，考虑到各种治疗途径，在大多数情况下手术是不可避免的。
