Coloproctology Unit of General and Digestive Surgery Service, Hospital Universitari Parc Tauli (Sabadell), Sabadell, Spain.
Colorectal Dis. 2013 Nov;15(11):1442-7. doi: 10.1111/codi.12449.
Severity of acute diverticulitis (AD) has traditionally been assessed using the Hinchey classification; however, this classification is predominantly a surgical one. The Neff classification provides an alternative classification based on CT findings. The aim of this study was to evaluate a modification of the Neff classification to select patients presenting with early-stage AD to receive outpatient management.
All patients with AD, presenting to a single unit, were prospectively studied. All patients underwent emergency abdominal CT and were assigned a Neff stage, including a modification (mNeff) to Neff Stage I. The Neff stages used were: Stage 0, uncomplicated diverticulitis; Diverticula, thickening of the wall, increased density of the pericolic fat; Stage I, locally complicated (our modification included substages Ia (localized pneumoperitoneum in the form of air bubbles) and Ib (local abscess); Stage II, complicated with pelvic abscess; Stage III, complicated with distant abscess; and Stage IV, complicated with other distant complications. Patients who presented with Stage 0 or Stage Ia were selectively managed as outpatients. Patients with comorbidity or the presence of the systemic inflammatory response syndrome (SIRS) were excluded.
Between February 2010 and January 2013, 205 patients (mean age 59 years; age range 25-90 years) presented with AD. One-hundred and forty-nine met the radiological criteria for potential outpatient treatment. After applying the exclusion criteria, 68 were eventually assigned to an outpatient programme. Sixty-four (94%) successfully completed the outpatient treatment protocol; four patients were readmitted.
Our mNeff classification allowed selected patients with AD to be successfully managed in an outpatient programme.
急性憩室炎（AD）的严重程度传统上采用 Hinchey 分类法进行评估；然而，这种分类主要是针对手术的。Neff 分类法提供了一种基于 CT 发现的替代分类法。本研究的目的是评估 Neff 分类法的一种改良方法，以选择患有早期 AD 的患者接受门诊管理。
前瞻性研究了单一单位就诊的所有 AD 患者。所有患者均行急诊腹部 CT 检查，并根据 Neff 分期进行分期，包括 Neff I 期的改良（mNeff）。使用的 Neff 分期如下：0 期，单纯性憩室炎；憩室，壁增厚，结肠旁脂肪密度增加；I 期，局部复杂（我们的改良包括 I a 期（气泡形式的局限性气腹）和 I b 期（局部脓肿）；II 期，合并骨盆脓肿；III 期，合并远处脓肿；IV 期，合并其他远处并发症。表现为 0 期或 Ia 期的患者选择性地作为门诊患者进行管理。排除有合并症或全身炎症反应综合征（SIRS）的患者。
2010 年 2 月至 2013 年 1 月，205 例（平均年龄 59 岁；年龄范围 25-90 岁）患者患有 AD。149 例符合潜在门诊治疗的放射学标准。应用排除标准后，最终有 68 例患者被分配到门诊治疗方案。64 例（94%）成功完成了门诊治疗方案；4 例患者再次入院。
我们的 mNeff 分类法允许选择的 AD 患者在门诊治疗方案中成功治疗。
