Department of Surgery, Meander Medisch Centrum, Amersfoort, The Netherlands.
Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, The Netherlands.
Ann Surg. 2019 Apr;269(4):612-620. doi: 10.1097/SLA.0000000000003033.
The aim of this study was to establish whether surgical or conservative treatment leads to a higher quality of life (QoL) in patients with recurring diverticulitis and/or ongoing complaints.
The 6 months' results of the DIRECT trial, a randomized trial comparing elective sigmoidectomy with conservative management in patients with recurring diverticulitis (>2 episodes within 2 years) and/or ongoing complaints (>3 months) after an episode of diverticulitis, demonstrated a significantly higher QoL after elective sigmoidectomy. The aim of the present study was to evaluate QoL at 5-year follow-up.
From January 2010 to June 2014, 109 patients were randomized to either elective sigmoidectomy (N = 53) or conservative management (N = 56). In the present study, the primary outcome was QoL measured by the Gastrointestinal Quality of Life Index (GIQLI) at 5-year follow-up. Secondary outcome measures were SF-36 score, Visual Analogue Score (VAS) pain score, EuroQol-5D-3L (EQ-5D-3L) score, morbidity, mortality, perioperative complications, and long-term operative outcome.
At 5-year follow-up, mean GIQLI score was significantly higher in the operative group [118.2 (SD 21.0)] than the conservative group [108.5 (SD 20.0)] with a mean difference of 9.7 (95% confidence interval 1.7-17.7). All secondary QoL outcome measures showed significantly better results in the operative group, with a higher SF-36 physical (P = 0.030) and mental score (P = 0.010), higher EQ5D score (P = 0.016), and a lower VAS pain score (P = 0.011). Twenty-six (46%) patients in the conservative group ultimately required surgery due to severe ongoing complaints. Of the operatively treated patients, 8 (11%) patients had anastomotic leakage and reinterventions were required in 11 (15%) patients.
Consistent with the short-term results of the DIRECT trial, elective sigmoidectomy resulted in a significantly increased QoL at 5-year follow-up compared with conservative management in patients with recurring diverticulitis and/or ongoing complaints. Surgeons should counsel these patients for elective sigmoidectomy weighing superior QoL, less pain, and lower risk of new recurrences against the complication risk of surgery.
本研究旨在确定在患有复发性憩室炎和/或持续性症状的患者中，手术治疗与保守治疗哪种方法能带来更高的生活质量（QoL）。
DIRECT 试验的 6 个月结果显示，与保守治疗相比，择期乙状结肠切除术可显著提高复发性憩室炎（2 年内发作超过 2 次）和/或憩室炎发作后持续存在症状（超过 3 个月）患者的 QoL。本研究旨在评估 5 年随访时的 QoL。
2010 年 1 月至 2014 年 6 月，109 例患者被随机分配至择期乙状结肠切除术组（N=53）或保守治疗组（N=56）。本研究的主要结局指标是 5 年随访时采用胃肠道生活质量指数（GIQLI）评估的 QoL。次要结局指标包括 SF-36 评分、视觉模拟评分（VAS）疼痛评分、EuroQol-5D-3L（EQ-5D-3L）评分、发病率、死亡率、围手术期并发症和长期手术结果。
5 年随访时，手术组的平均 GIQLI 评分[118.2（21.0）]显著高于保守组[108.5（20.0）]，差值为 9.7（95%置信区间 1.7-17.7）。手术组的所有次要 QoL 结局指标均显著优于保守组，SF-36 身体评分（P=0.030）和精神评分（P=0.010）更高、EQ5D 评分（P=0.016）更高、VAS 疼痛评分（P=0.011）更低。保守组 26 例（46%）患者因严重持续性症状最终需要手术治疗。在接受手术治疗的患者中，8 例（11%）患者发生吻合口漏，11 例（15%）患者需要再次干预。
与 DIRECT 试验的短期结果一致，与保守治疗相比，在患有复发性憩室炎和/或持续性症状的患者中，择期乙状结肠切除术可在 5 年随访时显著提高 QoL。外科医生应权衡手术治疗的 QoL 优势、更少的疼痛和更低的新发复发风险，与手术相关并发症风险，为这些患者提供择期乙状结肠切除术治疗的建议。
