Genser Laurent, Karoui Mehdi, Vaillant Jean-Christophe, Hannoun Laurent
Service de chirurgie digestive et hépato-bilio-pancréatique, AP-HP, groupe hospitalier de La Pitié-Salpêtrière, institut universitaire de cancérologie (Paris-VI), université Pierre-et-Marie-Curie, Paris.
Rev Prat. 2013 Jun;63(6):827-30.
Surgery for diverticulitis is usually discussed in two situations: in emergency to treat a diverticulitis related complication or electively to prevent the risk of diverticulitis recurrence (prophylactic colonic resection). Surgical treatment of complicated diverticulitis has gone to changes during the last decade thanks to advances in laparoscopic surgery and interventional radiology (drainage, embolization). Emergency surgery for diverticulitis is mainly indicated (90%) for infectious related complications and more rarely for bleeding or stenosis. Surgery is the standard treatment of peritonitis complicating diverticulitis (Hinchey 3 or 4) and is recommended in Hinchey 1 or 2 diverticulitis after failure of a well conducted medical treatment with or without radiological drainage (for abscesses >or= 5cm). Indications for prophylactic surgery after an episode of uncomplicated diverticulitis is not systematic and should be discussed case by case according to the baseline characteristics of patients. Prophylactic surgery consists in sigmoid resection including the sigmoido-rectal junction with colorectal anastomosis and should be performed under laparoscopy.
一是在紧急情况下治疗与憩室炎相关的并发症，二是选择性地预防憩室炎复发的风险（预防性结肠切除术）。由于腹腔镜手术和介入放射学（引流、栓塞）的进展，在过去十年中，复杂性憩室炎的外科治疗发生了变化。憩室炎的急诊手术主要用于治疗与感染相关的并发症（90%），较少用于治疗出血或狭窄。手术是治疗并发憩室炎的腹膜炎（欣奇分类3或4级）的标准方法，对于经规范药物治疗（无论有无放射学引流，用于治疗直径≥5cm的脓肿）失败后的欣奇分类1或2级憩室炎，也建议进行手术治疗。单纯性憩室炎发作后预防性手术的指征并不统一，应根据患者的基线特征逐案讨论。预防性手术包括乙状结肠切除术，切除范围包括乙状结肠直肠交界处，并进行结直肠吻合，手术应在腹腔镜下进行。
