Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Int J Colorectal Dis. 2021 Jan;36(1):103-115. doi: 10.1007/s00384-020-03721-9. Epub 2020 Sep 4.
The German Classification of Diverticular Disease was introduced a few years ago. The aim of this study was to determine whether Classification of Diverticular Disease enables an exact stratification of different types of diverticular disease in terms of course and treatment.
This was a prospective, bicentric observational trial. Patients aged ≥ 18 years with diverticular disease were prospectively included. The primary endpoint was the rate of recurrence within 2 year follow-up. Secondary outcome measures were Gastrointestinal Quality of Life Index, Quality of life measured by SF-36, frequency of gastrointestinal complaints, and postoperative complications.
A total of 172 patients were included. After conservative management, 40% of patients required surgery for recurrence in type 1b vs. 80% in type 2a/b (p = 0.04). Sixty percent of patients with type 2a (micro-abscess) were in need of surgery for recurrence vs. 100% of patients with type 2b (macro-abscess) (p = 0.11). Patients with type 2a reached 123 ± 15 points in the Gastrointestinal Quality of Life Index compared with 111 ± 14 in type 2b (p = 0.05) and higher scores in the "Mental Component Summary" scale of SF-36 (52 ± 10 vs. 43 ± 13; p = 0.04). Patients with recurrent diverticulitis without complications (type 3b) had less often painful constipation (30% vs. 73%; p = 0.006) when they were operated compared with conservative treatment.
Differentiation into type 2a and 2b based on abscess size seems reasonable as patients with type 2b required surgery while patients with type 2a may be treated conservatively. Sigmoid colectomy in patients with type 3b seems to have gastrointestinal complaints during long-term follow-up.
https://www.drks.de ID: DRKS00005576.
几年前引入了德国憩室疾病分类。本研究旨在确定憩室疾病分类是否能够根据病程和治疗对不同类型的憩室疾病进行准确分层。
这是一项前瞻性、双中心观察性试验。前瞻性纳入年龄≥18 岁的憩室疾病患者。主要终点是 2 年随访期间的复发率。次要结局指标为胃肠道生活质量指数、SF-36 测量的生活质量、胃肠道症状频率和术后并发症。
共纳入 172 例患者。经保守治疗后，1b 型患者中有 40%因复发需要手术，而 2a/b 型患者中有 80%需要手术（p=0.04）。2a 型（微脓肿）中有 60%的患者因复发需要手术，而 2b 型（大脓肿）中有 100%的患者需要手术（p=0.11）。2a 型患者的胃肠道生活质量指数达到 123±15 分，而 2b 型为 111±14 分（p=0.05），SF-36 的“心理成分综合评分”更高（52±10 比 43±13；p=0.04）。无并发症的复发性憩室炎患者（3b 型）在接受手术治疗时比保守治疗时更少有疼痛性便秘（30%比 73%；p=0.006）。
根据脓肿大小将憩室疾病分为 2a 和 2b 似乎是合理的，因为 2b 型患者需要手术治疗，而 2a 型患者可能可以保守治疗。3b 型患者行乙状结肠切除术似乎在长期随访中存在胃肠道不适。
https://www.drks.de ID：DRKS00005576。
