Dissanayake Bhanuka, Burstow Matthew J, Jeyakumar Arunan, Yuide Peter J, Gundara Justin, Chua Terence C
From the *School of Medicine, Griffith University, Gold Coast, Australia and.
†Department of Surgery, Logan Hospital, Meadowbrook, Australia.
Am Surg. 2020 Apr 1;86(4):308-312.
Acute diverticulitis is an emergency surgical condition that is commonly managed an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016-2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender ( = 0.039), increased length of hospital stay ( < 0.001), temperature ≥37.5 ( = 0.025), increased white cell count ( < 0.001), and elevated C-reactive protein ( < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diverticulitis with sepsis or peritonitis.
急性憩室炎是一种需紧急手术治疗的疾病，通常采用急性外科单元模式进行管理。在某些特定情况下，如弥漫性腹膜炎或瘘管病，需要进行手术治疗；然而，关于如何通过现代介入技术进行密切临床管理来挽救可能需要手术的临界患者的数据有限。本研究的目的是确定急性憩室炎的手术率以及识别复杂性憩室炎患者的预测因素。在昆士兰州洛根医院的一个大容量急性外科单元，对一个前瞻性维护的数据库进行了回顾性数据收集。收集患者的人口统计学数据、疾病相关因素和治疗相关因素用于报告和分析。在三年（2016 - 2018年）期间，201例（64%）患者因非复杂性憩室炎入院，113例（36%）患者因复杂性憩室炎入院。观察到非复杂性憩室炎的年入院人数呈下降趋势。复杂性憩室炎与男性性别相关（P = 0.039）、住院时间延长（P < 0.001）、体温≥37.5℃（P = 0.025）、白细胞计数升高（P < 0.001）和C反应蛋白升高（P < 0.001）有关。12例（11%）复杂性憩室炎患者最初保守治疗失败。7例（6%）患者接受了确定性的哈特曼手术，5例（4%）患者接受了经皮脓肿引流。急性憩室炎可以通过药物治疗和经皮脓肿引流进行安全的非手术管理，手术仅适用于伴有脓毒症或腹膜炎的复杂性憩室炎患者。
