Department of Abdominal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Dis Colon Rectum. 2014 Jul;57(7):875-81. doi: 10.1097/DCR.0000000000000083.
The optimal treatment for diverticulitis with extraluminal air is controversial.
The purpose of this research was to evaluate the safety and effectiveness of nonoperative treatment of acute diverticulitis with extraluminal air.
This was a retrospective cohort.
The study was conducted at an academic teaching hospital functioning as both a tertiary and secondary care referral center.
All of the patients with CT-diagnosed acute perforated diverticulitis with extraluminal air from 2006 through 2010 were included in this study.
Nonoperative treatment composed of intravenous antibiotics, bowel rest, and percutaneous drainage were the included interventions.
The need for operative management and mortality were measured.
A total of 132 patients underwent nonoperative treatment, whereas 48 patients were primarily operated on. Patients treated nonoperatively were divided into 3 groups on the basis of identified factors that independently predicted risk for failure: 1) patients with pericolic air (n = 82) without abscess had a 99% success rate with 0% mortality. 2) Patients with distant intraperitoneal air (n = 29) had a 62% success ratewith 0% mortality. Abundant distant intraperitoneal air and fluid in the fossa Douglas were identified as risk factors for failure. Patients without these risk factors had an 86% success rate with nonoperative management. 3) Patients with distant retroperitoneal air (n = 14) had a 43% success rate with 7% mortality.
Comparison of nonoperative versus operative treatment cannot be made because of the study's retrospective nature.
Nonoperative treatment of acute diverticulitis with extraluminal air is safe and effective in patients with a small amount of distant intraperitoneal air or pericolic air without clinical signs of peritonitis.
伴腔外积气的憩室炎的最佳治疗方法存在争议。
本研究旨在评估非手术治疗伴腔外积气的急性憩室炎的安全性和有效性。
这是一项回顾性队列研究。
该研究在一家学术教学医院进行，该医院既是三级和二级转诊中心。
所有 CT 诊断为伴腔外积气的急性穿孔性憩室炎患者均纳入本研究。
包括静脉内使用抗生素、肠道休息和经皮引流的非手术治疗。
手术管理的需求和死亡率。
共有 132 例患者接受了非手术治疗，而 48 例患者最初接受了手术。根据独立预测失败风险的因素，非手术治疗的患者分为 3 组：1）有结肠旁积气（n=82）而无脓肿的患者，成功率为 99%，死亡率为 0%。2）有远处腹腔内积气（n=29）的患者，成功率为 62%，死亡率为 0%。大量远处腹腔内积气和 Douglas 窝内液体被认为是失败的危险因素。无这些危险因素的患者，非手术治疗的成功率为 86%。3）有远处腹膜后积气（n=14）的患者，成功率为 43%，死亡率为 7%。
由于研究的回顾性性质，无法比较非手术治疗与手术治疗。
对于少量远处腹腔内积气或无腹膜炎临床征象的结肠旁积气的急性憩室炎患者，非手术治疗是安全有效的。
