Joliat Gaëtan-Romain, Emery Jonathan, Demartines Nicolas, Hübner Martin, Yersin Bertrand, Hahnloser Dieter
Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Emergency Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Int J Colorectal Dis. 2017 Sep;32(9):1313-1319. doi: 10.1007/s00384-017-2847-z. Epub 2017 Jun 29.
Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis (uD) and can be performed for mild complicated diverticulitis (mcD). In several cases, outpatient treatment (OT) can be undertaken. This study assessed the 1-month failure rate of OT for uD/mcD compared to inpatient treatment (IT), and identified predictive factors for treatment failure.
All consecutive patients (2006-2012) diagnosed with uD/mcD by CT scan were retrospectively analyzed. Acute uD was defined as absence of the following: abscess, fistula, extraluminal contrast, pneumoperitoneum, and need for immediate percutaneous drainage/surgery. Acute mcD was defined as complicated diverticulitis with abscess <4 cm or pneumoperitoneum <2 cm. All patients received antibiotherapy. Treatment failure was defined as (re)hospitalization the first month after treatment onset or need of drainage/surgery during hospitalization. All patients were contacted using a standardized questionnaire.
Out of 540 uD/mcD, IT was offered to 369 patients (68%) and OT to 171 patients (32%). The IT group had higher median age, more women, higher median Charlson Index, more severe median Ambrosetti score, longer median time in the emergency room, and higher median CRP. Response rates to the questionnaire were 56% (IT) vs. 62% (OT), p = 0.18. Failure rates were 32% in IT vs. 10% in OT group, p < 0.01. Among the uD/mcD patients, admission/CT time between midnight and 6 AM, Ambrosetti score of 4, and free air around the colon were risk factors for failure.
Outpatient treatment for uncomplicated/mild complicated diverticulitis is feasible and safe. Prognostic factors of failure necessitating closer follow-up were admission/CT time, Ambrosetti score of 4, and free air around the colon.
抗生素治疗是单纯性憩室炎（uD）的首选治疗方法，也可用于轻度复杂性憩室炎（mcD）。在某些情况下，可以进行门诊治疗（OT）。本研究评估了与住院治疗（IT）相比，uD/mcD门诊治疗的1个月失败率，并确定了治疗失败的预测因素。
对所有通过CT扫描诊断为uD/mcD的连续患者（2006 - 2012年）进行回顾性分析。急性uD定义为不存在以下情况：脓肿、瘘管、腔外造影剂、气腹以及立即进行经皮引流/手术的必要性。急性mcD定义为伴有脓肿<4 cm或气腹<2 cm的复杂性憩室炎。所有患者均接受抗生素治疗。治疗失败定义为治疗开始后第一个月内（再次）住院或住院期间需要进行引流/手术。使用标准化问卷对所有患者进行随访。
在540例uD/mcD患者中，369例（68%）接受了住院治疗，171例（32%）接受了门诊治疗。住院治疗组患者的年龄中位数更高，女性更多，Charlson指数中位数更高，Ambrosetti评分中位数更严重，在急诊室的时间中位数更长，CRP中位数更高。问卷回复率为住院治疗组56%，门诊治疗组62%，p = 0.18。住院治疗组的失败率为32%，门诊治疗组为10%，p < 0.01。在uD/mcD患者中，午夜至凌晨6点之间的入院/CT时间、Ambrosetti评分为4以及结肠周围有游离气体是失败的危险因素。
单纯性/轻度复杂性憩室炎的门诊治疗是可行且安全的。需要密切随访的失败预后因素为入院/CT时间、Ambrosetti评分为4以及结肠周围有游离气体。
