系统评价和荟萃分析急性单纯性憩室炎的治疗：是时候改变传统实践了。
Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice.
机构信息
Department of General and Colorectal Surgery, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Derby, UK.
Department of General Surgery, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK.
出版信息
Int J Colorectal Dis. 2024 Apr 5;39(1):47. doi: 10.1007/s00384-024-04618-7.
BACKGROUND
To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis.
METHODS
A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters.
RESULTS
The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61).
CONCLUSION
Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.
背景
评估门诊（OP）与住院（IP）治疗以及抗生素（ABX）与非抗生素（NABX）治疗单纯性（Hinchey 1a 级）急性憩室炎的比较结果。
方法
使用电子数据库进行系统的在线搜索。纳入了比较单纯性 Hinchey 1a 级急性憩室炎的 OP 与 IP 治疗以及 ABX 与 NABX 方法的研究。主要结局是憩室炎复发。急诊和择期手术切除、复杂憩室炎的发展、死亡率和住院时间是其他评估的次要结局参数。
结果
文献检索确定了 12 项研究（n=3875），比较了 NABX（n=2008）与 ABX（n=1867）。NABX 组的疾病复发率和住院时间均低于 ABX 组（P=0.01）和（P=0.004）。急诊切除（P=0.33）、择期切除（P=0.73）、复杂憩室炎的发展（P=0.65）、医院再入院（P=0.65）和 30 天死亡率（P=0.91）无显著差异。12 项研究（n=2286）比较了 OP（n=1021）与 IP（n=1265）治疗单纯性急性憩室炎。两组在以下结局方面相似：治疗失败（P=0.10）、急诊手术切除（P=0.40）、择期切除（P=0.30）、疾病复发（P=0.22）和死亡率（P=0.61）。
结论
在选择的临床稳定的单纯性急性憩室炎（Hinchey 1a 分级）患者中，仅观察治疗是可行且安全的。它可能提供更好的结果，包括缩短住院时间。此外，OP 治疗 Hinchey 1a 级急性憩室炎的方法与 IP 管理相当。未来需要高质量的随机对照研究来了解在 OP 环境中使用 NABX 方法治疗单纯性急性憩室炎患者的结局。
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