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[憩室炎的当前治疗方法:2016年的现状]

[Current treatment for diverticulitis: state of affairs in 2016].

作者信息

van Dijk S, Boermeester M A

机构信息

Academisch Medisch Centrum, afd. Chirurgie, Amsterdam.

出版信息

Ned Tijdschr Geneeskd. 2016;160:D69.

Abstract
  • Uncomplicated diverticulitis does not routinely require antibiotic treatment and can even be managed in the outpatient setting.- As yet no medical therapies have proven themselves useful in the prevention of recurrence.- Complicated diverticulitis with an abscess smaller than 4 cm is treated with antibiotics, larger abscesses are treated by percutaneous drainage, and only if treatment fails surgery is required.- Laparoscopic lavage is no better than partial resection in purulent peritonitis.- Perforated diverticulitis with faecal peritonitis is treated by a Hartmann's procedure; in selected cases resection and primary anastomosis may be considered.- The decision whether a resection should be laparoscopic or open is based on the surgeon's experience.- The choice for elective resection for recurrent diverticulitis is still made on a patient-by-patient basis.- Only high-risk patients should have a follow-up colonoscopy to exclude malignancy. The remaining patients are referred back to the Dutch national colorectal cancer screening programme.
摘要
  • 单纯性憩室炎通常不需要抗生素治疗,甚至可以在门诊处理。

  • 目前尚无医学疗法被证明对预防复发有效。

  • 脓肿小于4 cm的复杂性憩室炎采用抗生素治疗,较大脓肿采用经皮引流,仅在治疗失败时才需要手术。

  • 在脓性腹膜炎中,腹腔镜灌洗并不比部分切除更好。

  • 伴有粪性腹膜炎的穿孔性憩室炎采用Hartmann手术治疗;在特定情况下可考虑切除并一期吻合。

  • 手术应选择腹腔镜还是开放手术取决于外科医生的经验。

  • 复发性憩室炎择期切除的选择仍需根据患者个体情况决定。

  • 只有高危患者应进行结肠镜随访以排除恶性肿瘤。其余患者转回荷兰国家结直肠癌筛查项目。

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