Kevin CW Hsiao, Chang-Chieh Wu, Shu-Wen Jao, Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
World J Gastroenterol. 2013 Oct 21;19(39):6613-7. doi: 10.3748/wjg.v19.i39.6613.
To investigate the comorbid disease could be the predictors for the elective colectomy in colonic diverticulitis.
A retrospective chart review of 246 patients with colonic diverticulitis admitted between 2000 and 2008 was conducted, and 19 patients received emergent operation were identified and analyzed. Data were collected with regard to age, sex, albumin level on admission, left or right inflammation site, the history of recurrent diverticulitis, preoperative comorbidity, smoking habits, medication, treatment policy, morbidity, and mortality. Preoperative comorbid diseases included cardiovascular disease, diabetes, pulmonary disease, peptic ulcer disease, gouty arthritis, and uremia. Medications in use included non-steroidal anti-inflammatory drugs, acetylsalicylic acid (Aspirin), and corticosteroids. Univariate and multivariate logistic regression analyses were performed to identify the relevant risk factors correlating to colectomy.
The mean age of the 246 patients was 69.5 years (range, 24-94 years). Most diverticulitis could be managed with conservative treatment (n = 227, 92.3%), and urgent colectomy was performed in 19 patients (7.7%). There were three deaths in the surgical group and four deaths in the nonsurgical group. The overall mortality rate in the study was 1.7% among patients with conservative treatment and 15.7% among patients undergoing urgent colectomy. Multiple logistic regression analysis indicated that comorbidities were risk factors for urgent colectomy for diverticulitis.
To avoid high mortality and morbidity related to urgent colectomy, we suggest that patients with colonic diverticulitis and comorbid diseases may require elective colectomy.
探讨合并症是否为择期结肠切除术治疗憩室炎的预测因素。
对 2000 年至 2008 年间收治的 246 例憩室炎患者进行回顾性病历分析，其中 19 例患者接受了急诊手术。分析了患者的年龄、性别、入院时白蛋白水平、左/右侧炎症部位、复发性憩室炎病史、术前合并症、吸烟习惯、用药情况、治疗方案、发病率和死亡率。术前合并症包括心血管疾病、糖尿病、肺部疾病、消化性溃疡病、痛风性关节炎和尿毒症。使用的药物包括非甾体类抗炎药、乙酰水杨酸（阿司匹林）和皮质类固醇。采用单因素和多因素逻辑回归分析确定与结肠切除术相关的相关危险因素。
246 例患者的平均年龄为 69.5 岁（24-94 岁）。大多数憩室炎可通过保守治疗（n=227，92.3%）得到控制，19 例患者（7.7%）需要紧急结肠切除术。手术组有 3 例死亡，非手术组有 4 例死亡。在接受保守治疗的患者中，总的死亡率为 1.7%，而在接受紧急结肠切除术的患者中，死亡率为 15.7%。多因素逻辑回归分析表明，合并症是憩室炎紧急结肠切除术的危险因素。
为了避免与紧急结肠切除术相关的高死亡率和发病率，我们建议患有结肠憩室炎和合并症的患者可能需要择期结肠切除术。
