Lambrichts Daniël P V, Birindelli Arianna, Tonini Valeria, Cirocchi Roberto, Cervellera Maurizio, Lange Johan F, Bemelman Willem A, Di Saverio Salomone
Erasmus University Medical Center Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
Academic Medical Center Amsterdam, Department of Surgery, Amsterdam, The Netherlands.
Inflamm Intest Dis. 2018 Dec;3(2):80-90. doi: 10.1159/000486677. Epub 2018 Feb 16.
Acute complicated diverticulitis (ACD) is an important and increasing issue in Western countries that leads to a significant impact and burden for patients, but also for the society due to its effects on hospital costs. In recent years, essential progression has been made regarding the research and implementation of novel or improved treatment strategies for the various disease entities of ACD. Much debated topics in the multidisciplinary approach of patients with ACD, such as the choice for nonoperative treatment options, the role of percutaneous drainage for diverticular abscesses, the role of laparoscopic lavage for perforated diverticulitis with purulent peritonitis, and the role of sigmoidectomy with primary anastomosis for patients with perforated diverticulitis, require clinicians to attentively follow and participate in these discussions.
The aim of this review article is to provide clinicians with a structured overview of the recent literature on the multidisciplinary management of complicated diverticulitis by a panel of experts on the topic. By performing an extensive literature search in the online medical databases MEDLINE (Ovid) and Embase, insights into nonoperative treatment, percutaneous drainage, minimally invasive and open surgical treatment of ACD are provided. Furthermore, a comprehensive algorithm for the treatment of ACD has been developed.
Accurate patient evaluation and selection based on patient and disease characteristics is of paramount importance to determine the appropriate treatment strategy for patients with complicated diverticulitis. The presence of an experienced surgeon with advanced skills in laparoscopic emergency colorectal surgery is crucial for the treatment of patients with perforated diverticulitis in order to properly evaluate, select and treat patients suitable for nonoperative or operative treatment with an open or laparoscopic approach.
急性复杂性憩室炎（ACD）在西方国家是一个重要且日益突出的问题，它不仅给患者带来重大影响和负担，还因其对医院成本的影响给社会带来负担。近年来，在ACD各种疾病实体的新型或改进治疗策略的研究和实施方面取得了重要进展。在ACD患者的多学科治疗方法中，有许多备受争议的话题，如非手术治疗方案的选择、经皮引流在憩室脓肿治疗中的作用、腹腔镜灌洗在伴有脓性腹膜炎的穿孔性憩室炎治疗中的作用以及乙状结肠切除术加一期吻合术在穿孔性憩室炎患者治疗中的作用，这些都要求临床医生密切关注并参与这些讨论。
这篇综述文章的目的是由该领域的专家小组为临床医生提供关于复杂性憩室炎多学科管理的近期文献的结构化概述。通过在在线医学数据库MEDLINE（Ovid）和Embase中进行广泛的文献检索，提供了对ACD非手术治疗、经皮引流、微创和开放手术治疗的见解。此外，还制定了一个全面的ACD治疗算法。
基于患者和疾病特征进行准确的患者评估和选择对于确定复杂性憩室炎患者的适当治疗策略至关重要。拥有熟练掌握腹腔镜急诊结直肠手术高级技能的经验丰富的外科医生对于穿孔性憩室炎患者的治疗至关重要，以便正确评估、选择和治疗适合非手术或开放或腹腔镜手术治疗的患者。
