The Countess of Chester Hospital, Chester, UK.
Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Suite D-361, Taylor Pavilion, 100 Woods Rd, Valhalla, NY, 10595, USA.
Int J Colorectal Dis. 2021 Jul;36(7):1367-1383. doi: 10.1007/s00384-021-03899-6. Epub 2021 Mar 7.
The aim of this study was to assess failure rates following nonoperative management of acute diverticulitis complicated by abscess and trends thereof.
Pubmed, MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science were systematically searched. Nonoperative management was defined as a combination of nil per os, IV fluids, IV antibiotics, CT scan-guided percutaneous drainage, and total parenteral nutrition. The primary endpoint was failure of nonoperative management defined as persistent or worsening abscess and/or sepsis, development of new complications, such as peritonitis, ileus, or colocutaneous fistula, and urgent surgery within 30-90 days of index admission. Data were stratified by three arbitrary time intervals: 1986-2000, 2000-2010, and after 2010. The primary outcome was calculated for those groups and compared.
Thirty-eight of forty-four eligible studies published between 1986 and 2019 were included in the quantitative synthesis of data (n = 2598). The pooled rate of failed nonoperative management was 16.4% (12.6%, 20.2%) at 90 days. In studies published in 2000-2010 (n = 405), the pooled failure rate was 18.6% (10.5%, 26.7%). After 2000 (n = 2140), the pooled failure rate was 15.3% (10.7%, 20%). The difference was not statistically significant (p = 0.725). After controlling for heterogeneity in the definition of failure of nonoperative management, subgroup analysis yielded the pooled rate of failure of 21.8% (16.1%, 27.4%).
This meta-analysis found that failure rates following nonoperative management of acute diverticulitis complicated by abscess did not significantly decrease over the past three decades. The general quality of published data and the level and certainty of evidence produced were low.
本研究旨在评估伴有脓肿的急性憩室炎非手术治疗后的失败率及其变化趋势。
系统检索了 PubMed、MEDLINE、EMBASE、CINAHL、Cochrane 图书馆和 Web of Science。非手术治疗定义为禁食、静脉补液、静脉使用抗生素、CT 引导下经皮引流和全胃肠外营养的联合治疗。主要终点是指非手术治疗失败，定义为脓肿持续或加重和/或脓毒症、出现新的并发症（如腹膜炎、肠梗阻或肠皮肤瘘）以及在入院后 30-90 天内紧急手术。数据按照三个任意时间段进行分层：1986-2000 年、2000-2010 年和 2010 年后。计算并比较了这些组的主要结局。
纳入了 1986 年至 2019 年间发表的 44 篇符合条件的研究中的 38 篇（n=2598）进行了数据的定量综合分析。90 天的非手术治疗失败率为 16.4%（12.6%，20.2%）。在 2000-2010 年发表的研究（n=405）中，失败率为 18.6%（10.5%，26.7%）。2000 年后（n=2140），失败率为 15.3%（10.7%，20%）。差异无统计学意义（p=0.725）。在控制非手术治疗失败定义的异质性后，亚组分析得出的失败率为 21.8%（16.1%，27.4%）。
本荟萃分析发现，过去三十年来，伴有脓肿的急性憩室炎非手术治疗后的失败率并没有显著下降。发表数据的总体质量以及产生的证据水平和确定性都较低。
