Lock Johan, Wiegering A, Germer C-T
Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
Chirurg. 2021 Aug;92(8):694-701. doi: 10.1007/s00104-021-01432-7. Epub 2021 Jun 7.
The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality.
Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence.
The narrative review is based on current national and international guidelines and a selective literature search.
There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1-3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment.
The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks.
正确的医学指征是手术治疗及确保质量的基本决策过程。
根据当前证据水平描述各类憩室病的手术治疗指征。
叙述性综述基于当前的国内和国际指南以及选择性文献检索。
乙状结肠切除基本上有三个主要指征。1）在急性复杂性憩室炎经成功保守治疗形成大脓肿且复发风险高（憩室病分类，CDD，2b型）后，为避免并发症而进行预防性切除。2）对于有持续症状且生活质量受损的各类乙状结肠切除术患者（CDD 1 - 3型），可有效显著改善生活质量，因此在围手术期风险个体可接受的情况下应予以推荐。3）乙状结肠紧急切除的指征为游离穿孔或保守治疗失败。
手术指征应根据憩室病类型、手术治疗目的、与保守治疗相比手术治疗效果的评估以及对风险的个体评估来确定。
