Galetin T, Galetin A, Vestweber K-H, Rink A D
Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
Int J Colorectal Dis. 2018 Mar;33(3):261-272. doi: 10.1007/s00384-017-2960-z. Epub 2018 Jan 18.
Diverticular disease is common and of increasing medical and economical importance. Various practice guidelines on diagnostic and treatment on this disease exist. We compared current guidelines on the disease in order to identify concordant and discordant recommendations.
Eleven national and international guidelines on diverticular disease published over the last 10 years have been identified by a systematic literature review on PubMed and compared in detail for 20 main and 51 subtopics.
The available evidence for the most aspects was rated as moderate or low. There was concordance for the following items: Diagnosis of diverticulitis should be confirmed by imaging methods (10 of 10 guidelines). Mild forms may be treated out-patient (10/10). Abscesses are treated non-surgically (9/9). Elective surgery should be indicated by individual patient-related factors, only, and be performed laparoscopically (10/10, 9/9 respectively). Main differences were found in the questions of appropriate classification, imaging diagnostic (computed-tomography versus ultra-sound), need for antibiotics in out-patient treatment and mode of surgery for diverticular perforation. Despite growing evidence that antibiotics are not needed for treating mild diverticulitis, only 3/10 guidelines have corresponding recommendations. Hartmann's procedure has been abandoned several years ago and is now recommended for feculent peritonitis by the three most recent guidelines. In contrast, laparoscopic lavage without resection is not recommended anymore.
There are dissents in the recommendations for central aspects regarding the diagnostic and treatment of diverticular disease in recently published guidelines.
憩室病很常见，在医学和经济方面的重要性日益增加。关于这种疾病的诊断和治疗有各种实践指南。我们比较了当前关于该疾病的指南，以确定一致和不一致的建议。
通过对PubMed的系统文献综述，确定了过去10年发布的11项关于憩室病的国家和国际指南，并对20个主要主题和51个子主题进行了详细比较。
大多数方面的现有证据被评为中等或低等。在以下项目上存在一致性：憩室炎的诊断应通过影像学方法确认（10项指南中的10项）。轻度形式可门诊治疗（10/10）。脓肿采用非手术治疗（9/9）。择期手术仅应由与患者个体相关的因素决定，并通过腹腔镜进行（分别为10/10和9/9）。在适当分类、影像诊断（计算机断层扫描与超声）、门诊治疗中抗生素的需求以及憩室穿孔的手术方式等问题上发现了主要差异。尽管越来越多的证据表明轻度憩室炎无需使用抗生素，但只有3/10的指南有相应建议。哈特曼手术几年前已被摒弃，最近的三项指南现在推荐用于粪性腹膜炎。相比之下，不再推荐不进行切除的腹腔镜灌洗术。
在最近发布的指南中，关于憩室病诊断和治疗的核心方面的建议存在分歧。
