左侧结肠憩室炎诊断与治疗体会：队29例报告

本文介绍我院４６年收治的２９例左侧结肠憩室炎病人的诊治情况。２９例全部进行手术，其中急忙仍手术２２例，择期手术７例，诊断主要依靠病史、体征、泛影葡胺灌肠和ＣＴ检查。提出急忙仍手术与择期手术的手术指征，手术方式的选择方法。对各种手术方式的利弊作了比较。因结肠憩室炎易复发，复发周期在３－４个月，因此择期手术强调在第一次复发后３个月作手术，又因年轻病人予铂常较严重，强调第一次发作后３－４周积极行手术治疗     

结肠憩室炎急性穿孔的外科处理（附四例分析）

目的　探讨结肠憩室炎穿孔的临床表现与处理。方法　收治结肠憩室炎急性穿孔患者4例 ,年龄 5 5～ 71岁。 4例手术治疗。对其临床资料及外科治疗进行回顾性分析。结果　死亡 1例 ,切口感染 1例 ,3例痊愈出院。结论　结肠憩室炎急性穿孔处理应根据患者全身状况和腹腔污染等情况综合判定。关键是切除病变 ,控制脓毒败血症休克 ,防治合并症 ,引流通畅。对 4 0岁以下结肠憩室炎及顽固性便秘的多发性憩室炎患者 ,预防性结肠大部切除可防止憩室穿孔的发生     

超声在不同分型急性结肠憩室炎诊断中的价值

目的 观察超声诊断单纯型及复杂型急性结肠憩室炎的价值。方法 回顾性分析17例急性结肠憩室炎患者的临床、超声及CT资料,分析超声诊断急性结肠憩室炎的价值。结果 17例中,11例接受超声检查,其中单纯型8例、复杂型3例。7例单纯型超声表现为局部结肠肠壁增厚,结肠边缘见囊袋状凸起,边界清,憩室周围可见高回声包绕;1例病灶位于升结肠,结肠边缘见囊袋状凸起,憩室内见高密度粪石,肠壁增厚伴周围脂肪密度升高,超声漏诊后经CT检出。3例复杂型超声均表现为憩室周围低回声包块,与周围肠管、膀胱分界不清。超声结合临床准确诊断10例(90.91%,10/11)急性结肠憩室炎,包括7例(7/8,87.50%)单纯型和3例(3/3,100%)复杂型。结论 超声有助于诊断急性结肠憩室炎,尤其复杂型急性结肠憩室炎。     

左侧结肠憩室炎诊断与治疗体会（附29例报告）

本文介绍我院４６年来收治的２９例左侧结肠憩室炎病人的诊治情况。２９例全部作了手术，其中急诊手术２２例，择期手术７例。诊断主要依靠病史、体征、泛影葡胺灌肠和ＣＴ检查。提出急诊手术与择期手术的手术指征，手术方式的选择方法。对各种手术方式的利弊作了比较。因结肠憩室炎易复发，复发周期在３～４个月．因此择期手术强调在第一次复发后３个月作手术。又因年轻病人予后常较严重，强调第一次发作后３～４周积极行手术治疗。     

盲肠憩室炎9例临床分析

1989～1997年,我院共收治盲肠憩室炎9例,现将其临床特点、术中所见和急诊处理报告如下。 1 临床资料 本组9例,男6例,女3例,年龄28～72岁;20～40岁5例,40～60岁3例,大于60岁1例,平均44岁。症状:本组中8例因右下腹疼痛,或转移性右下腹疼痛伴恶心、呕吐等消化道症状诊断为急性阑尾炎而手术治疗,其中体温>37℃者6例,白细胞>10×10~9/L 3例,伴右下腹肿块者1例。1例因右     

憩室炎发作后行结肠内镜检查的意义

近年来,憩室炎与结直肠癌之间可能存在的关系一直是争论的焦点。van de Wall BJ等人探讨了评估憩室炎发生后行常规结肠内镜检查的益处。     

结肠憩室炎误诊为急性阑尾炎的临床分析（附四例报告）

目的　探讨结肠憩室炎的临床特点及其与急性阑尾炎的区别。方法　对我院近 4年来收治的 6例结肠憩室炎临床资料进行分析。结果　误诊为急性阑尾炎 4例 ,后经剖腹探查确诊。结论　误诊的主要原因为结肠憩室炎发病率低 ,临床表现无特异性 ,医务人员对该疾病认识不够。排除诊断可以减少本病的误诊 ,对腹部疼痛原因不明的患者行X线检查及纤维结肠镜检查 ,有利于明确诊断     

腹腔镜与剖腹急诊结肠切除术治疗穿孔性结肠憩室炎疗效对比的Meta分析

目的:应用Meta分析的方法,对比腹腔镜与传统剖腹结肠切除术治疗穿孔性结肠憩室炎的近期效果。方法:检索PubMed、Embase、Cochrane Library、中国知网与万方数据库已公开发表的有关腹腔镜与剖腹结肠切除术治疗穿孔性结肠憩室炎近期效果对比研究的临床文献。采用R软件与RevMan 5.3软件对符合条件的结果进行Meta分析。结果:共纳入7篇文献、11 540例患者,其中腹腔镜组2 449例,剖腹组9 091例。腹腔镜组术后并发症发生率、术后死亡率、术后住院时间低于剖腹组,手术时间长于剖腹组。腹腔镜组中转开腹率为33%。两组非计划再手术率差异无统计学意义。结论:腹腔镜结肠切除术治疗穿孔性结肠憩室炎的手术效果并不劣于剖腹手术。由经验丰富的外科医师施术,可能取得较剖腹手术更好的效果。     

Difficult diagnosis of right-sided colonic diverticulitis

A giant colonic diverticulum is a rare entity, generally located into the sigmoid colon. We report the case of a giant colonic diverticulum in an young women which was intraoperatively diagnosed, during exploratory laparoscopy, in spite of normal colonoscopy.     

Conservative approach is feasible in the management of acute diverticulitis of the right colon

Background: Acute diverticulitis of the caecum and ascending colon is uncommon. Controversies abound as regards the optimal surgical treatment, ranging from appendectomy, diverticulectomy to right hemicolectomy. The aim of the present paper was to review treatment strategy followed by a critical appraisal. Methods: The case notes of 30 patients with acute diverticulitis of the right colon who were treated at the United Christian Hos­pital, Hong Kong from 1992 to 1998 were systematically reviewed. The data were subjected to statistical analysis. Results: The median age was 34 years, with a male:female ratio of 1:1.15. All patients presented with acute right lower abdominal pain and localized rebound tenderness. All were diagnosed preoperatively as having appendicitis. The mean duration of symptoms was 2 days (range: 1–6 days). Two treatment groups were identified. Group A (n = 16; 53%) received appendicectomy alone, while group B (n = 14; 47%) underwent diverticulectomy in addition to appendicectomy, including one patient with perforated diverticulitis. Overall, there was no procedure‐related morbidity or mortality. Both groups received a similar duration of broad‐spectrum anti­biotics. All the patients were interviewed by phone after operation to detect any recurrence of symptoms, with a median follow‐up interval of 34 months (range: 11–78 months). There was no recurrence of symptoms in group A, which received appendicectomy and antibiotics. The only difference was operative time. Conclusion: For non‐perforated diverticulitis of the right colon, appendicectomy and intravenous antibiotics without diverticulectomy is the preferred treatment strategy.     

Nonoperative management of right colonic diverticulitis using radiologic evaluation

Objective Although a few reviews have been conducted, nonoperative management may be the mainstay of therapy for uncomplicated right colonic diverticulitis. With increasing use of radiological evaluation for diverticulitis, the status of the disease is becoming more accessible. In this study, clinical outcomes of nonoperative management for right colonic diverticulitis were assessed according to disease status using radiological evaluation. Method From April 2000 to March 2007, 296 patients were admitted for acute right colonic diverticulitis upon first attack and were treated with nonoperative management. The status of diverticulitis was classified using ultrasonography and/or computed tomography as inflamed diverticulum or phlegmon in 276 patients or pericolic abscess in 20 patients. Uncomplicated diverticulitis was defined as inflamed diverticulum or phlegmon. Length of hospital stay, antibiotic use, failure of initial therapy and the incidence of recurrence after nonoperative management were assessed. Results The mean length of hospital stay and antibiotic use were 6 and 4.7 days respectively. All patients were successfully treated with the initial medical therapy and their hospital stays were uneventful. Of the 276 patients with an uncomplicated diverticulitis, two patients (1%) had a recurrence during follow‐up that could be managed nonoperatively. Of the 20 patients with pericolic abscesses, four patients (20%) had a recurrence. One patient underwent laparoscopic ileocolic resection and the other patients were treated nonoperatively. Conclusion Nonoperative management may be the treatment of choice for right colonic diverticulitis with inflamed diverticulum or phlegmon. Diverticulitis with pericolic abscess should be treated with additional care.     

Impact of age on recurrence and severity of left colonic diverticulitis

Aim There has been controversy about the presentation and treatment of acute colonic diverticulitis (AD) in young patients. The aim of this observational study was to evaluate the virulence and natural history of AD in three different age groups of patients. Method The study was performed on 686 patients with the diagnosis of a first episode of AD admitted between January 1998 and December 2008. Patients were classified into three groups: age 45 years or younger (group 1), 45–70 years of age (group 2) and 70 years or more (group 3). The variables studied were gender, American Society of Anesthesiologists status, associated comorbidity, type of treatment, length of hospital stay and recurrence of AD. Results Group 1 included 99 (14.4%) patients, group 2 339 (49.4%) and group 3 248 (36.2%). Of these, 144 patients needed emergency operation at the first admission, 25 underwent elective surgery after the first episode of AD and 10 died after medical treatment; 507 patients were followed for recurrence. In all, 104 (20.5%) patients had a recurrence of AD that required hospitalization. Fifty (9.9%) presented with one episode of severe recurrence, without any difference between the groups (P = 0.533). There were no differences in the analysis of cumulative recurrence (Kaplan–Maier) between the three groups. Conclusion AD does not present a more aggressive clinical course in younger patients and it can be safely managed using the same strategy as in middle aged and older patients.     

回盲部憩室炎的诊治探讨

目的探讨回盲部憩室炎的诊断和手术方式的选择。方法12例回盲部憩室炎患者,其中Meckel憩室炎7例,盲肠憩室炎4例,升结肠憩室炎1例。根据憩室部位、大小及周围肠管是否受累选择手术方式,包括憩室单纯切除术、回肠部分切除 端端吻合术、回盲部切除 回肠升结肠端侧吻合术 回肠造瘘术等。结果全组患者均获治愈,无手术并发症发生。结论回盲部憩室炎与急性阑尾炎临床表现极为相似,常需术中探查方能确诊。应根据憩室的具体情况选择合适的术式。     

Current status of the treatment of acute colonic diverticulitis: a systematic review

Aim This paper addresses the current status of the treatment of acute colonic diverticulitis by an evidence‐based review. Method A systematic search in PUBMED, MEDLINE, EMBASE and Google scholar on colonic diverticulitis was performed. Diagnostic tools, randomized controlled trials, non‐randomized comparative studies, observational epidemiological studies, national and international guidelines, reviews of observational studies on elective and emergency surgical treatment of diverticulitis, and studies of prognostic significance were reviewed. Criteria for eligibility of the studies were diagnosis and classification, medical treatment, inpatients and outpatients, diverticulitis in young patients, immunosuppression, recurrence, elective resection, emergency surgery, and predictive factors. Results Some 92 publications were selected for comprehensive review. The review highlighted that computed tomography is the most effective test in the diagnosis and staging of acute diverticulitis; outpatient treatment can be performed for uncomplicated diverticulitis in patients without associated comorbidities; conservative treatment is aimed at those patients with uncomplicated acute diverticulitis; elective surgery must be done on an individual basis; laparoscopic approach for elective treatment of diverticulitis is appropriate but may be technically complex; in perforated diverticulitis, resection with primary anastomosis is a safe procedure that requires experience and should take into account strict exclusion criteria. Conclusion The heterogeneity of patients with colonic diverticular disease means that both elective and urgent treatment should be tailored on an individual basis.     

Diagnostic ultrasound of acute colonic diverticulitis by surgical residents

Background: Recent studies have documented the feasibility of ultrasonography (US) to diagnose acute colonic diverticulitis (ACD). This prospective observational trial determined the sonomorphology of ACD and evaluated the diagnostic accuracy of routine US performed on admission by surgeons in training. Methods: Fifty-seven consecutive patients with a confirmed episode of ACD were entered into this study, and the sonomorphology of the involved colon was assessed. US findings were compared to the results of the clinical evaluation and correlated to the clinicopathological outcome. Results: The sonomorphology of ACD was characterized by segmental inflammatory transformation of the colon averaging 9.9 ± 3.2 cm (range, 6–20) in length and visualized as target phenomena of a mean 3.5 ± 0.8 cm (range, 2.4–4.8) width. Targets were caused by hypoechogenic thickening of the colonic wall of an average 7.7 ± 2.6 mm (range, 4–18). In 40% of cases, a hyperechogenic halo representing peridiverticulitis (average width, 2.3 ± 0.6; range, 1.2–3 cm) was noted. Diverticula were seen in almost half of the cases. Of the 57 cases with confirmed ACD, the diagnosis was made by US in 48, for a global accuracy of 84.2%. US was false negative in nine patients, suggesting perforated appendicitis in five cases and acute appendicitis in one (the final diagnoses were perforated sigmoid diverticulitis in five cases and cecal diverticulitis in one case). In three patients, US was nondiagnostic. Conclusion: In the hands of sonographically trained surgeons, ultrasound is a useful modality to image acute colonic diverticulitis. US reveals diagnostic sonomorphology in most cases of ACD and therefore facilitates early confirmation of the diagnosis and assessment of severity. Received: 3 October 1996/Accepted: 9 May 1997     

原发性结肠淋巴瘤的诊断和治疗

目的 探讨原发性结肠淋巴瘤(primary colonic malignant lymphoma,PCML)的诊断和治疗方法.方法 回顾性分析12例经手术病理证实为PCML的临床资料,包括患者的主要临床表现、病理、手术治疗和预后,对比研究钡灌肠、结肠镜和多层螺旋CT(muhislice spiral computed tomography.MSCT)等诊断方法.结果 PCML常见的临床表现为:腹痛、腹胀、腹部肿物、肠梗阻、消化管出血,血清肿瘤指标均正常.术前12例患者中,6例行钡灌肠检查,2例检出病变,均未提示淋巴瘤可能.6例行结肠镜检查,3例检出病变,1例提示淋巴瘤可能.10例行MSCT检查,CT初诊检出肿瘤9例,定性诊断准确5例;12例患者均行手术治疗,无围手术期死亡.术后病理结果:12例均为非霍奇金淋巴瘤,除1例为T细胞来源,其余均为B细胞淋巴瘤.术后10例患者接受辅助化疗,11例获随访,1年、3年生存率分别为81.9%(9/11)、54.5%(6/11).结论 PCML无特异性临床症状,钡灌肠和结肠镜检查诊断率低.MSCT扫描在PCML的诊断中具有独特的优越性,结合临床具有较高的诊断价值.手术和术后辅助治疗是治疗早期PCML的重要手段.