急性复杂性憩室炎后的择期手术：是否仍属必要？
Elective operation after acute complicated diverticulitis: is it still mandatory?
作者信息
Bridoux Valérie, Antor Marlène, Schwarz Lilian, Cahais Julien, Khalil Haitham, Michot Francis, Tuech Jean-Jacques
机构信息
Valérie Bridoux, Marlène Antor, Lilian Schwarz, Julien Cahais, Haitham Khalil, Francis Michot, Jean-Jacques Tuech, Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen Cedex, France.
出版信息
World J Gastroenterol. 2014 Jul 7;20(25):8166-72. doi: 10.3748/wjg.v20.i25.8166.
AIM
To investigate recurrence rates, patterns and complications after nonoperatively managed complicated diverticulitis (CD).
METHODS
A retrospective study of patients treated for CD was performed. CD was defined on computed tomography by the presence of a localized abscess, pelvic abscess or extraluminal air. For follow-up, patients were contacted by telephone. Numbers of elective surgeries, recurrences and abdominal pain were analyzed.
RESULTS
A total of 114 patients (median age 57 years (range 29-97)), were admitted for CD. Nine patients required surgical intervention for failure of conservative therapy (Hartmann's procedure: n = 6; resection and colorectal anastomosis: n = 3). Of the 105 remaining patients, 24 (22.9%) underwent elective sigmoid resection. The 81 (71%) non-operated patients were all contacted after a median follow-up of 32 mo (4-63). Among them, six had developed a recurrent episode of diverticulitis at a median follow-up of 12 mo (6-36); however, no patient required hospitalization. Sixty-eight patients (84%) were asymptomatic and 13 (16%) had recurrent abdominal pain.
CONCLUSION
Conservative policy is feasible and safe in 71% of cases, with a low medium-term recurrence risk.
目的
研究非手术治疗复杂性憩室炎（CD）后的复发率、复发模式及并发症。
方法
对接受CD治疗的患者进行回顾性研究。CD在计算机断层扫描上定义为存在局部脓肿、盆腔脓肿或腔外气体。通过电话联系患者进行随访。分析择期手术的数量、复发情况及腹痛情况。
结果
共有114例患者（中位年龄57岁（范围29 - 97岁））因CD入院。9例患者因保守治疗失败需要手术干预（Hartmann手术：n = 6；切除及结直肠吻合术：n = 3）。在其余105例患者中，24例（22.9%）接受了择期乙状结肠切除术。81例（71%）未手术患者在中位随访32个月（4 - 63个月）后均被联系。其中，6例在中位随访12个月（6 - 36个月）时出现憩室炎复发；然而，无患者需要住院治疗。68例患者（84%）无症状，13例（16%）有复发性腹痛。
结论
在71%的病例中，保守治疗策略是可行且安全的，中期复发风险较低。
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