Department of Surgery, Jeroen Bosch Hospital, Hertogenbosch, the Netherlands.
Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid, Nijmegen, the Netherlands.
Scand J Gastroenterol. 2024 Jul;59(7):770-780. doi: 10.1080/00365521.2024.2337833. Epub 2024 Apr 13.
Recurrences or persistent symptoms after an initial episode of diverticulitis are common, yet surgical treatment is rarely performed. Current guidelines lack clear recommendations on whether or not to operate, even though recent studies suggest an improved quality of life following surgery. The aim of this study is therefore to compare quality of life in patients with recurrent or ongoing diverticulitis treated conservatively versus surgically, giving a more definitive answer to the question of whether or not to operate on these patients.
A systematic literature search was conducted in EMBASE, MEDLINE and Cochrane. Only comparative studies reporting on quality of life were included. Statistical analysis included calculation of weighted mean differences and pooled odds ratios.
Five studies were included; two RCT's and three retrospective observational studies. Compared to conservative treatment, the SF-36 scores were higher in the surgically treated group at each follow-up moment but only the difference in SF-36 physical scores at six months follow-up was statistically significant (MD 6.02, 95%CI 2.62-9.42). GIQLI scores were also higher in the surgical group with a MD of 14.01 (95%CI 8.15-19.87) at six months follow-up and 7.42 (95%CI 1.23-12.85) at last available follow-up. Also, at last available follow-up, significantly fewer recurrences occurred in the surgery group (OR 0.10, 95%CI 0.05-0.23, < 0.001).
Although surgery for recurrent diverticulitis is not without risk, it might improve long-term quality of life in patients suffering from recurrent- or ongoing diverticulitis when compared to conservative treatment. Therefore, it should be considered in this patient group.
初次发作憩室炎后复发或持续存在症状较为常见，但很少进行手术治疗。目前的指南缺乏明确的手术治疗建议，尽管最近的研究表明手术治疗后生活质量有所改善。因此，本研究旨在比较保守治疗与手术治疗复发性或持续性憩室炎患者的生活质量，以更明确地回答是否对这些患者进行手术的问题。
在 EMBASE、MEDLINE 和 Cochrane 中进行系统文献检索。仅纳入报告生活质量的比较研究。统计分析包括计算加权均数差和汇总优势比。
纳入了 5 项研究，包括 2 项 RCT 和 3 项回顾性观察性研究。与保守治疗相比，手术治疗组在每个随访时间的 SF-36 评分均较高，但只有 6 个月随访时的 SF-36 生理评分差异具有统计学意义（MD6.02，95%CI2.62-9.42）。手术组的 GIQLI 评分也较高，6 个月随访时 MD 为 14.01（95%CI8.15-19.87），最后一次随访时 MD 为 7.42（95%CI1.23-12.85）。此外，在最后一次随访时，手术组的复发率显著较低（OR0.10，95%CI0.05-0.23， < 0.001）。
尽管复发性憩室炎手术存在风险，但与保守治疗相比，手术可能会改善复发性或持续性憩室炎患者的长期生活质量。因此，在该患者群体中应考虑手术治疗。
