Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy.
Department of Surgical Sciences, Umberto I University Hospital - La Sapienza, Rome, Italy.
Dig Dis Sci. 2020 Dec;65(12):3463-3476. doi: 10.1007/s10620-020-06621-8. Epub 2020 Sep 27.
The medical and surgical management of uncomplicated diverticulitis has changed over the last several years. Although immunocompetent patients or those without comorbidities can be treated with antibiotics as an outpatient, the efficacy of high-fiber intake or drugs such as mesalamine or rifaximin is not yet clearly established in the treatment of acute episodes and in the prevention of recurrences. On the other hand, the choice between antibiotic treatment and percutaneous drainage is not always obvious in diverticulitis complicated by abscess formation, especially for larger abscesses; although the results of studies comparing the two approaches remain controversial, surgery must be pursued for abscesses > 8 cm. For emergency surgery, the debate is still ongoing regarding laparoscopic lavage and surgical resection followed by primary anastomosis, since for both approaches the published reports are not in agreement regarding possible benefits. Therefore, these approaches are recommended only for selected patients under the care of experienced surgeons. Also, the contribution of elective surgery toward the overall approach has been revised; currently, it is reserved primarily for patients with a high risk of recurrence and whenever more conservative treatments were not effective.
在过去的几年中，单纯性憩室炎的医学和外科治疗已经发生了变化。尽管免疫功能正常的患者或无合并症的患者可以在门诊接受抗生素治疗，但在急性发作和预防复发中，高纤维摄入或美沙拉嗪或利福昔明等药物的疗效尚未明确确立。另一方面，在脓肿形成的憩室炎中，抗生素治疗和经皮引流之间的选择并不总是很明显，尤其是对于较大的脓肿；尽管比较两种方法的研究结果仍存在争议，但对于直径大于 8 厘米的脓肿，必须进行手术。对于急诊手术，腹腔镜灌洗和手术切除后行一期吻合术的争论仍在继续，因为对于这两种方法，发表的报告在可能的益处方面并不一致。因此，这些方法仅推荐给经验丰富的外科医生治疗的选定患者。此外，择期手术对整体治疗方法的贡献也进行了修订；目前，它主要保留给复发风险高的患者，以及任何时候更保守的治疗方法都无效的患者。
