Department of Surgery, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
Int J Colorectal Dis. 2021 Aug;36(8):1791-1799. doi: 10.1007/s00384-021-03913-x. Epub 2021 Mar 25.
Right-sided diverticulitis has different epidemiologic features compared to left-sided diverticulitis. However, data on the appropriate treatment of right-sided diverticulitis are lacking. This systematic review aimed to examine the outcomes of conservative treatment for uncomplicated right-sided diverticulitis.
MEDLINE, Embase, and the Cochrane Library were searched for articles published from January 1, 1990, to May 31, 2020. A total of 21 studies were included in the systematic review. We calculated proportions and 95% confidence intervals (CIs) to assess the outcomes of individual studies and pooled the results using a random effects model.
A total of 2811 patients (59.1% men; mean and median age, 37-54 years) with right-sided diverticulitis were included. The pooled rate of treatment failure was 2.5% (95% CI 1.2-4.3%; p <0.01; I = 64.0%). The recurrence rate ranged from 0 to 26.9%, and the pooled recurrence rate was 10.9% (95% CI 8.1-14.1%; p <0.01; I = 78.2%). The pooled rate of complicated diverticulitis at recurrence was 4.4% (95% CI 1.4-9.0%; p = 0.84; I = 0%). The pooled rate of emergency surgery at recurrence was 9.0% (95% CI 4.6-14.7%; p = 0.12; I = 30.3%).
Conservative treatment of uncomplicated right-sided diverticulitis results in a low rate of recurrence and complicated diverticulitis at recurrence. Based on these results, unnecessary surgery may be avoided and a new treatment paradigm for uncomplicated right-sided diverticulitis may be introduced.
与左侧憩室炎相比，右侧憩室炎具有不同的流行病学特征。然而，目前缺乏关于右侧憩室炎适当治疗的数据。本系统评价旨在研究非复杂性右侧憩室炎保守治疗的结果。
检索 1990 年 1 月 1 日至 2020 年 5 月 31 日期间发表的 MEDLINE、Embase 和 Cochrane 图书馆中的文章。系统评价共纳入 21 项研究。我们计算了各个研究结果的比例和 95%置信区间（CI），以评估其结果，并使用随机效应模型对结果进行汇总。
共纳入 2811 例（59.1%为男性；平均和中位数年龄为 37-54 岁）右侧憩室炎患者。治疗失败的总体发生率为 2.5%（95%CI 1.2-4.3%；p<0.01；I=64.0%）。复发率范围为 0-26.9%，总体复发率为 10.9%（95%CI 8.1-14.1%；p<0.01；I=78.2%）。复发时并发复杂性憩室炎的总体发生率为 4.4%（95%CI 1.4-9.0%；p=0.84；I=0%）。复发时行急诊手术的总体发生率为 9.0%（95%CI 4.6-14.7%；p=0.12；I=30.3%）。
非复杂性右侧憩室炎的保守治疗后复发率和复发时并发复杂性憩室炎的发生率均较低。基于这些结果，可能避免不必要的手术，并为非复杂性右侧憩室炎引入新的治疗模式。
