憩室炎初次发作后的长期随访:13 年更新。

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Sarah N Anwar, Gabrielle E Dombek, Caroline Hayes, Maggie J McMahon, Cody Munroe, Jonathan S Abelson, Jason F Hall, David A Kleiman, Angela H Kuhnen, Peter W Marcello, Julia T Saraidaridis
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引用次数: 0

摘要

背景:对于复发性憩室炎患者而言,是否需要进行选择性乙状结肠切除术尚不明确。目前的临床实践指南建议这是外科医生和患者之间的个体化决定:评估憩室炎复发的长期风险,并确定疾病复发的预测因素:设计:回顾性病例系列:患者患者:2002-2008 年间连续住院或门诊的 CT 证实的憩室炎患者:干预措施:通过病历审查和问卷调查确定憩室炎复发率:主要结果测量:憩室炎复发或手术治疗憩室炎的风险:共发现753名首次患憩室炎的患者。患者年龄为 61.5 岁(SD 15.3)。中位随访时间为 13.2 年(IQR 3.8-18.3)。随访时有 486 名(64.5%)患者存活。在初次就诊时,有 29 人(3.9%)需要进行红外引流,37 人(4.9%)需要进行急诊手术。43人(5.7%)在初次发病后接受了择期手术,77人(10.2%)在发病超过一次后接受了手术。在首次发病未接受手术的患者中,有 353 人(52.4%)病情复发,中位复发时间为 2.9 年(IQR 0.83-8.5 年)。多变量分析显示,女性(HR 1.28,P = 0.04)、乙状结肠疾病(HR 1.35,P = 0.03)、烟雾病(HR 3.17,P < 0.01)、受累区段长度 >5 厘米(HR 1.28,P = 0.04)和最大脂肪束直径 >1.8 厘米(HR 1.29,P = 0.03)与疾病复发有关。卡普兰-麦尔估计的复发率分别为:首次发病后 1 年为 73.1%(69.6-76.3%),5 年为 47.9%(44.0-51.6%),10 年为 34.6%(31.0-38.2%):局限性:回顾性设计:结论:单次憩室炎发作后,长期随访的复发率超过 50%。女性性别、乙状结肠疾病、烟雾病、受累区段长度大于 5 厘米、最大脂肪束直径大于 1.8 厘米等变量与复发风险增加有关。在指导患者决定是否进行选择性结肠切除术时,应考虑这些研究结果。参见视频摘要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term Follow-up After an Initial Episode of Diverticulitis: A 13- Year Update.

Background: For patients with recurrent diverticulitis, the trigger to proceed to elective sigmoid colectomy is unclear. Current clinical practice guidelines suggest this is an individualized decision between surgeon and patient.

Objective: To assess long-term risk of diverticulitis recurrence and determine predictors of recurrent disease.

Design: Retrospective case series.

Setting: Tertiary care center.

Patients: Consecutive patients with CT-proven diverticulitis who presented as inpatient or outpatient between 2002-2008.

Interventions: Incidence of diverticulitis recurrence determined via chart review and questionnaire.

Main outcome measures: Risk of recurrent diverticulitis or surgery for diverticulitis.

Results: A total of 753 patients with first-time diverticulitis were identified. Patients were 61.5 years old (SD 15.3). Median follow-up was 13.2 years (IQR 3.8-18.3). There were 486 (64.5%) patients alive at time of follow-up. During initial presentation, 29 (3.9%) required IR drainage and 37 (4.9%) required emergency surgery. Forty-three (5.7%) underwent elective surgery after initial presentation, and 77 (10.2%) underwent surgery after more than 1 episode. Of those without surgery for first episode, 353 (52.4%) experienced recurrent disease with median time to recurrence of 2.9 years (IQR 0.83-8.5 years). On multivariate analysis, female sex (HR 1.28, p = 0.04), sigmoid disease (HR 1.35, p = 0.03), smoldering disease (HR 3.17, p < 0.01), length of involved segment >5 cm (HR 1.28, p = 0.04), and maximum fat stranding diameter >1.8 cm (HR 1.29, p = 0.03) were associated with disease recurrence. Kaplan Meier estimates of freedom from recurrence were 73.1% (69.6-76.3%) at 1 year, 47.9% (44.0-51.6%) at 5 years, and 34.6% (31.0-38.2%) at 10 years following initial presentation.

Limitations: Retrospective design.

Conclusions: After a single episode of diverticulitis, incidence of recurrence is more than 50% on long-term follow-up. Variables such as female sex, sigmoid disease, smoldering disease, length of involved segment greater than 5 cm, and maximum fat stranding diameter greater than 1.8 cm were associated with an increased risk of recurrence. These findings should be considered when counseling patients on decision to proceed with elective colectomy. See Video Abstract.

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来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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