结直肠憩室病554例临床分析  

Clinical analysis of 554 patients with colorectal diverticulosis

作　　者：张峻岭[1] 滕贵根[2] 吴涛[1] 陈国卫[1] 王鹏远[1] 姜勇[1] 武颖超[1] 孙烈[1] 刘涛[1] 左帅[1] 潘义生[1] 汪欣[1] Zhang Junling;Teng Guigen;Wu Tao;Chen Guowei;Wang Pengyuan;Jiang Yong;Wu Yingchao;Sun Lie;Liu Tao;Zuo Shuai;Pan Yisheng;Wang Xin(Department of General Surgery,Peking University First Hospital,Beijing 100034,China;Department of Gastroenterology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院普通外科,100034 [2]北京大学第一医院消化内科,100034

出　　处：《中华胃肠外科杂志》2021年第11期1008-1014,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81641098);北京市中医药科技发展资金项目(JJ2018-05);北京大学医学青年培育基金(BMU2020PYB026);北京大学第一医院青年临床研究专项基金(2018CR23、2021CR03);北京大学第一医院科研种子基金(2018SF090)。

摘　　要：目的结直肠憩室病患者多数无临床症状,易被忽视;但其并发症如憩室炎、憩室出血甚至憩室穿孔对患者危害极大。本研究旨在分析结直肠憩室病的发病情况、临床特点和诊治方法,以为临床诊治憩室病提供参考。方法采用描述性病例系列研究的方法。纳入北京大学第一医院于2009年1月至2019年6月期间收治的经CT、肠镜、消化道造影或经手术证实的结直肠憩室病554例患者的临床资料进行分析,排除伴有恶性肿瘤、自身免疫性疾病和长期服用免疫抑制性药物者、伴有慢性肝、肾功能衰竭者和认知功能障碍患者。分析指标包括患者性别、发病年龄、临床症状、病变部位、治疗方案以及转归。结肠憩室炎分级参照世界急诊外科学学会(WSES)制定的标准分为5级,0级为单纯性憩室炎;1~4级为复杂性憩室炎。结果554例结直肠憩室病患者中,男性358例(64.6%),中位年龄63岁。191例(34.5%)伴有不同程度的消化道症状,其中113例(20.4%)慢性便秘和腹胀,78例(14.1%)为慢性腹泻和腹痛。有406例患者经结肠镜检查发现,465例经CT检查发现,25例经消化道造影检查发现,3例为术中发现。其中多发憩室339例(61.2%),单发憩室215例(38.8%)。病变位于结肠424例(76.5%),其中升结肠者205例(37.0%);结直肠多部位118例(21.3%),直肠12例(2.2%)。憩室直径中位数7 mm,其中≥30 mm者78例(14.1%)。49例(8.8%)表现为急性憩室炎,其中13例为单纯性,36例为复杂性。36例复杂性憩室炎中,男性29例(80.6%),发病前反复发作腹痛伴发热27例(75.0%);9例并发乙状结肠穿孔,8例并发乙状结肠或直肠上段憩室膀胱瘘,均予以手术治疗;另有19例临床表现为消化道出血,其中男性18例,病变位于升结肠者11例;13例经保守治疗后治愈,4例内镜下止血,2例手术。结论结直肠憩室病以男性多见,CT和结肠镜为主要诊断方法。复杂结肠憩室炎的症状与憩室位置有关,除采Objective Most patients with asymptomatic colorectal diverticulosis are easily overlooked.However,some of diverticulosis become diverticulitis,bleeding and even perforation,which cause extensive harm to patients.The purpose of this study is to analyze the incidence,clinical features,diagnosis and treatment of colorectal diverticulosis in order to improve the clinical understanding of diverticulosis and its related complications.Methods A descriptive cohort study was carried out.Clinical data of 554 patients with colorectal diverticulosis confirmed by CT,colonoscopy,digestive tract radiography or operation in Peking University First Hospital from January 2009 to June 2019 were retrospectively analyzed.Patients with malignant tumors,autoimmune diseases,long term use of immunosuppressive drugs,chronic liver diseases and renal diseases,and mental disorders were excluded.The analysis parameters included gender,onset age,clinical symptoms,location of diverticulitis,treatment and prognosis.According to the criteria established by the World Society of Emergency Surgery(WSES),acute diverticulitis was divided into 5 stages based on the extension of the infectious process.Stage 0 was simple diverticulitis and stage 1-4 was complicated diverticulitis.Results Among the 554 patients with colorectal diverticulosis,358(64.6%)were males,the median onset age was 63 years;191 patients(34.5%)had various digestive symptoms,of whom 113(20.4%)had chronic constipation and abdominal distension,78(14.1%)had chronic diarrhea and abdominal pain;the other 363 patients had no obvious abdominal symptoms.Four hundred and six patients were found by colonoscopy and 465 patients were found by CT.Twenty-five patients were diagnosed by lower gastrointestinal tract radiography and 3 were confirmed during operation.There were 339 patients with multiple diverticula(61.2%)and 215 patients with single diverticulum(38.8%).76.5%(424/554)of diverticula were located in colon,37.0%(205/554)in ascending colon,21.3%(118/554)in multiple sites,and 2.2%(12/554)in

关 键 词：憩室病 结肠直肠 结肠镜 断层扫描术 电子计算机 外科手术 

分 类 号：R574.6[医药卫生—消化系统]