Ambrosetti P, Robert J, Witzig J A, Mathey P, Mirescu D, Rohner A
Clinique de chirurgie digestive, Hôpital cantonal universitaire de Genève.
Schweiz Med Wochenschr. 1993 May 29;123(21):1118-20.
This prospective study focuses on the prediction of late outcome after acute left colonic diverticulitis successfully treated conservatively and in which the diagnosis was confirmed radiologically (computed tomography [CT] and gastrografin enema [GE]). Acute diverticulitis was diagnosed in 226 patients. Sixty-six patients (29%) were operated on during their first hospitalization, and 2 of them died (3% mortality). The remaining 160 patients, successfully treated conservatively, had a CT and a GE within 72 hours of admission and entered this study. Signs of severity on CT included the presence of abscess(es) and/or extraluminal air and/or extraluminal hydrosoluble contrast (Gastrografin). Follow-up averaged 25 months (range 1 month to 5.3 years). Twenty-seven of these 160 patients (17%) had a poor outcome (persistent diverticulitis in 12, colonic stenosis in 6, recurrences in 7, residual parasigmoid abscess and colovesical fistula in one each). When comparing these 27 patients with the 133 others it appeared that: (1) men up to 50 years of age were significantly more prone to develop such complications (p = 0.003); (2) the probability of developing a complication was significantly greater when the initial CT had revealed an abscess and/or extraluminal air and/or extraluminal Gastrografin (p = 0.005). These results support the view that elective colectomy can reasonably be proposed after a first attack of acute left diverticulitis treated conservatively in men up to 50 years of age, and/or in patients whose initial CT revealed findings of severe diverticulitis.
这项前瞻性研究聚焦于急性左半结肠憩室炎经保守治疗成功且经放射学确诊（计算机断层扫描[CT]和气钡灌肠[GE]）后的远期预后预测。226例患者被诊断为急性憩室炎。66例患者（29%）在首次住院期间接受了手术，其中2例死亡（死亡率3%）。其余160例经保守治疗成功的患者在入院72小时内接受了CT和GE检查并进入本研究。CT上的严重程度迹象包括存在脓肿和/或腔外气体和/或腔外水溶性造影剂（泛影葡胺）。随访平均25个月（范围1个月至5.3年）。这160例患者中有27例（17%）预后不良（12例持续性憩室炎，6例结肠狭窄，7例复发，1例残留乙状结肠旁脓肿和1例结肠膀胱瘘）。将这27例患者与其他133例患者进行比较时发现：（1）50岁及以下男性发生此类并发症的可能性显著更高（p = 0.003）；（2）初始CT显示有脓肿和/或腔外气体和/或腔外泛影葡胺时发生并发症的概率显著更高（p = 0.005）。这些结果支持这样一种观点，即在50岁及以下男性急性左半结肠憩室炎首次发作经保守治疗后，和/或初始CT显示有严重憩室炎表现的患者中，可以合理地建议进行择期结肠切除术。
