Department of Surgery, Weill Medical College of Cornell University, New York, New York.
Dis Colon Rectum. 2019 Mar;62(3):371-378. doi: 10.1097/DCR.0000000000001295.
Uncomplicated colonic diverticulitis is common. There is no consensus regarding the most appropriate management. Some authors have reported the efficacy and safety of observational management, and others have argued for a more aggressive approach with oral or intravenous antibiotic treatment.
The purpose of this study was to perform an updated meta-analysis of the different management strategies for uncomplicated diverticulitis with 2 separate meta-analyses.
MEDLINE, Embase, and Cochrane databases were used.
All randomized clinical trials, prospective, and retrospective comparative studies were included.
Observational and antibiotics treatment or oral and intravenous antibiotics treatment were included.
Successful management (emergency management, recurrence, elective management) was measured.
After review of 293 identified records, 11 studies fit inclusion criteria: 7 studies compared observational management and antibiotics treatment (2321 patients), and 4 studies compared oral and intravenous antibiotics treatment (355 patients). There was no significant difference between observational management and antibiotics treatment in terms of emergency surgery (0.7% vs 1.4%; p = 0.1) and recurrence (11% vs 12%; p = 0.3). In this part, considering only randomized trials, elective surgery during the follow-up occurred more frequently in the observational group than the antibiotic group (2.5% vs 0.9%; p = 0.04). The second meta-analysis showed that failure and recurrence rates were similar between oral and intravenous antibiotics treatment (6% vs 7% (p = 0.6) and 8% vs 9% (p = 0.8)).
Inclusion of nonrandomized studies, identification of high risks of bias (selection, performance, and detection bias), and presence of heterogeneity between the studies limited this work.
Observational management was not statistically different from antibiotic treatment for the primary outcome of needing to undergo surgery. However, in patients being treated by antibiotics, our studies demonstrated that oral administration was similar to intravenous administration and provided lower costs. Although it may be difficult for physicians to do, there is mounting evidence that not treating uncomplicated colonic diverticulitis with antibiotics is a viable treatment alternative.
单纯性结肠憩室炎很常见。对于最合适的治疗方法，尚无共识。一些作者报道了观察性治疗的疗效和安全性，而另一些作者则主张采用更积极的方法，即口服或静脉用抗生素治疗。
本研究旨在通过 2 项单独的荟萃分析，对单纯性憩室炎的不同治疗策略进行最新的荟萃分析。
使用 MEDLINE、Embase 和 Cochrane 数据库。
纳入所有随机临床试验、前瞻性和回顾性对照研究。
观察治疗和抗生素治疗或口服和静脉用抗生素治疗均包括在内。
成功治疗（急诊治疗、复发、择期治疗）。
在审查了 293 份已确定的记录后，有 11 项研究符合纳入标准：7 项研究比较了观察治疗和抗生素治疗（2321 例患者），4 项研究比较了口服和静脉用抗生素治疗（355 例患者）。在急诊手术（0.7% vs. 1.4%；p = 0.1）和复发（11% vs. 12%；p = 0.3）方面，观察治疗和抗生素治疗之间无显著差异。在这部分，仅考虑随机试验，在随访期间，观察组接受择期手术的比例高于抗生素组（2.5% vs. 0.9%；p = 0.04）。第二次荟萃分析显示，口服和静脉用抗生素治疗的失败率和复发率相似（6% vs. 7%（p = 0.6）和 8% vs. 9%（p = 0.8））。
纳入非随机研究、确定存在高偏倚风险（选择、执行和检测偏倚）以及研究之间存在异质性，限制了本项研究。
在需要手术这一主要结局方面，观察治疗与抗生素治疗在统计学上无差异。然而，在接受抗生素治疗的患者中，我们的研究表明，口服给药与静脉给药相似，且成本更低。尽管医生可能难以做到，但越来越多的证据表明，不使用抗生素治疗单纯性结肠憩室炎是一种可行的治疗选择。
