Sartelli Massimo, Binda Gian Andrea, Brandara Francesco, Borasi Andrea, Feroci Francesco, Vadalà Salvatore, Labricciosa Francesco M, Birindelli Arianna, Luridiana Gianluigi, Coccolini Federico, Di Saverio Salomone, Catena Fausto, Ansaloni Luca, Campanile Fabio Cesare, Agresta Ferdinando, Piazza Diego
Department of Surgery, Macerata Hospital, Macerata, Italy.
Department of Surgery, Galliera Hospital, Genoa, Italy.
World J Surg. 2017 Mar;41(3):851-859. doi: 10.1007/s00268-016-3800-y.
In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments.
IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter.
Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate.
The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.
近年来，尽管缺乏有力证据，但急性左半结肠憩室炎（ALCD）的急诊管理已发生了巨大变化。因此，管理策略常常由外科医生的个人偏好而非科学证据来指导。IPOD研究（意大利前瞻性观察性憩室炎研究）的主要目的是描述意大利外科科室中ALCD患者的诊断和治疗情况。
IPOD研究是一项前瞻性观察性研究，为期6个月（从2015年4月1日至2015年9月1日），纳入了89个意大利外科科室。所有经影像学检查确诊且由外科医生诊治的疑似临床诊断为ALCD的连续患者均纳入本研究。该研究由意大利医院外科医生协会和世界急诊外科学会意大利分会推动。
1125例患者纳入了IPOD研究，中位年龄为62岁[四分位间距（IQR），51 - 74岁]。1054例（93.7%）患者住院，中位住院时间为7天（IQR 5 - 10天）。828例患者（73.6%）仅接受药物治疗，13例患者进行了经皮引流（1.2%），另外284例（25.2%）患者接受手术作为首次治疗。在121例弥漫性腹膜炎患者中，71例（58.7%）接受了Hartmann切除术。然而，即使在ALCD较低分期的患者中（36/479；7.5%）也使用了Hartmann切除术，而其他治疗选择可能更合适。
IPOD研究表明，在意大利外科科室中，ALCD的治疗策略常常由外科医生的个人偏好所指导。
