Velez-Padilla Jonathan, Pastrana Del Valle Jonathan, Cavallaro Paul
Department of General Surgery, University of South Florida College of Medicine, Tampa, Florida.
Division of Colorectal Surgery, University of South Florida College of Medicine, Tampa, Florida.
Clin Colon Rectal Surg. 2024 Sep 30;38(4):263-268. doi: 10.1055/s-0044-1791497. eCollection 2025 Jul.
Acute diverticulitis is a common sequela of colonic diverticulosis that often poses a significant dilemma for surgeons and patients considering surgical management of the disease. Importantly, the decision to recommend surgery for patients with diverticular disease hinges on identifying those who will benefit most in terms of preventing future disease-related complications. This review focuses on identifying patient risk factors that are predictive of onset of diverticulitis, recurrence of disease, and progression to complicated disease, such as abscess, fistula, or stricture, and aims to assist clinicians with counseling patients who are considering surgery versus medical management. Specifically, a variety of modifiable and nonmodifiable risk factors have been identified across several studies that have strong associations with the development of diverticulitis, recurrence of uncomplicated disease, and progression to complicated disease. A handful of clinical scores have been described to guide surgeons and patients on their individual risk; however, none have been adopted into wider clinical practice. A novel polygenic risk score does show promise in potentially fulfilling this role. Nevertheless, there is significant room for innovation and development of new methods to risk-stratify patients presenting with the spectrum of diverticular disease.
急性憩室炎是结肠憩室病的常见后遗症，对于考虑对该疾病进行手术治疗的外科医生和患者来说，常常构成重大难题。重要的是，对于憩室病患者推荐手术的决定取决于确定那些在预防未来与疾病相关的并发症方面最受益的患者。本综述着重于确定可预测憩室炎发作、疾病复发以及进展为复杂疾病（如脓肿、瘘管或狭窄）的患者风险因素，旨在帮助临床医生为考虑手术与药物治疗的患者提供咨询。具体而言，多项研究已确定了多种可改变和不可改变的风险因素，这些因素与憩室炎的发生、非复杂性疾病的复发以及进展为复杂疾病密切相关。已经描述了一些临床评分来指导外科医生和患者了解其个体风险；然而，尚无一种被广泛应用于临床实践。一种新的多基因风险评分在潜在发挥这一作用方面确实显示出前景。尽管如此，在对患有各种憩室病的患者进行风险分层的新方法的创新和开发方面仍有很大空间。
