Ozick L A, Salazar C O, Donelson S S
Department of Medicine, Harlem Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY 10037.
Gastroenterologist. 1994 Dec;2(4):299-310.
Diverticular disease of the colon is a disease of twentieth century Western society. A diverticulum is an outpouching of mucosa through the colonic wall. Etiology and pathogenesis are related to altered colonic structure and physiology in an aging population. Epidemiological evidence suggests that a decrease in dietary fiber, as well as increasing age, lead to formation of diverticula. Diverticular disease includes pain without inflammation, diverticulitis, and bleeding. Severe diverticulitis is often complicated by abscess or fistula formation or peritonitis. Young obese men and immunocompromised patients have a more virulent course. Diverticular bleeding occurs as a result of a diverticulum eroding through a nutrient artery. Treatment of diverticular disease depends on severity and clinical presentation. A higher-fiber diet is recommended if there is no acute inflammation. Broad-spectrum antibiotics, diagnostic and therapeutic computed tomography scans, and early surgical intervention have improved the treatment of hospitalized patients with diverticular disease. The one-stage operation has increased in popularity for patients with localized disease because it reduces reoperative rates and hospitalization costs. Mortality remains high in patients with purulent and fecal peritonitis, and early recognition and treatment may benefit this subset of patients.
结肠憩室病是20世纪西方社会的一种疾病。憩室是黏膜通过结肠壁向外突出形成的囊袋。病因和发病机制与老年人群结肠结构和生理改变有关。流行病学证据表明，膳食纤维减少以及年龄增长会导致憩室形成。憩室病包括无炎症的疼痛、憩室炎和出血。严重的憩室炎常并发脓肿、瘘管形成或腹膜炎。年轻肥胖男性和免疫功能低下患者病情往往更严重。憩室出血是由于憩室侵蚀营养动脉所致。憩室病的治疗取决于病情严重程度和临床表现。如果没有急性炎症，建议采用高纤维饮食。广谱抗生素、诊断性和治疗性计算机断层扫描以及早期手术干预改善了住院憩室病患者的治疗。对于局限性疾病患者，一期手术越来越受欢迎，因为它降低了再次手术率和住院费用。化脓性和粪性腹膜炎患者的死亡率仍然很高，早期识别和治疗可能使这部分患者受益。
