摘要
目的分析急性结肠憩室炎的临床特征并探讨导致复发的可能因素。方法回顾性收集2015年1月至2019年10月北京大学第一医院急诊科收治的急性结肠憩室炎患者为研究对象,收集的临床资料包括性别、年龄、病变位置、首次外周血白细胞计数(WBC)和中性粒细胞百分比(NE%)、世界急诊外科学学会(WSES)分级、治疗方法及治疗后复发情况等。将研究对象依据治疗后是否复发分为未复发组和复发组,比较两组在临床资料上的差异。结果共入组154例,未复发组99例,复发组55例。①男97例,女57例,男女比例1.70∶1.00。年龄16~89岁,平均年龄(46.44±15.26)岁。60岁以下患者125例(81.2%);②急性右半结肠憩室炎(acute right-sided colonic diverticulitis,ARCD)143例(92.9%);急性左半结肠憩室炎(acute left-sided colonic diverticulitis,ALCD)11例(7.1%);③ARCD患者中主诉腹痛142例(99.3%)、发热29例(20.3%),有转移性右下腹痛表现的44例(30.8%),查体为右下腹压痛125例(86.7%)。ALCD患者中腹痛10例(90.9%)、发热5例(45.5%)、腹泻3例(27.2%)、便血1例(9.1%),查体为左腹部压痛(包括左侧腹弥漫性压痛3例)11例(100.0%);④未复发组与复发组年龄、性别、腹痛、发热、便血、腹泻、恶心呕吐、病变位置、首次外周血WBC及NE%差异无统计学意义(P>0.05);⑤0级患者97例(63.0%),治疗后复发36例(37.1%);1A级患者29例(18.8%),复发6例(20.7%);1B级患者7例(4.6%),复发4例(57.1%);2A级患者9例(5.8%),复发5例(55.6%);2B级患者7例(4.6%),复发3例(42.9%);3级患者4例(2.6%),手术治疗2例,复发1例(25.0%);4级患者1例(0.6%),行手术治疗,未复发;⑥未复发组与复发组WSES分级差异无统计学意义(Z=-0.118,P>0.05);复发组的憩室粪石(23.6%vs.5.1%,χ^(2)=11.832,P=0.001)和炎症累及阑尾(45.5%vs.10.1%,χ^(2)=25.163,P=0.000)的比例较高,差异有统计学意义(P<0.05);⑦复发时WSES分级较初发时未升高42例,复发时WSES分级升高的为13例。憩室有粪石的患者复发后WSES分级更易升高(69.2%vs.9.5%,χ^(2)=19.607,P=0.000),差异有统计学意义(P<0.05)。复发后WSES分级未升高患者与升高患者炎症累及阑尾差异无统计学意义(47.6%vs.38.5%,χ^(2)=0.336,P>0.05)。结论急性结肠憩室炎以男性多见,60岁以下患者为主。ARCD更为常见,临床表现主要为右下腹痛,可表现为转移性右下腹痛。憩室有粪石或炎症累及阑尾的患者治疗后复发率高,憩室有粪石的患者复发后WSES分级易升高。
Objective To analyze the clinical characteristics of acute colonic diverticulitis and to explore the possible factors leading to recurrence.Methods Patients with acute colonic diverticulitis admitted to the emergency department of Peking University First Hospital from January 2015 to October 2019 were retrospectively collected for the study,and the clinical data included gender,age,lesion location,white blood cell count(WBC)and neutrophil percentage(NE%)for the first time,the World Society of Emergency Surgery(WSES)classification,treatment,and recurrence status.The patients were divided into non-recurrence and recurrence groups according to whether they recurred after the treatment,and the differences in clinical data between the two groups were compared.Results A total of 154 cases were enrolled.There were 99 cases in non-recurrence group and 55 cases in recurrence group.①97 cases were male and 57 cases were female,with a male-to-female ratio of 1.70∶1.00.The age of patients ranged from 16 to 89 years old,with a mean age of(46.44±15.26)years old.125 patients(81.2%)were under 60 years old.②There were 143 cases of acute right-sided colonic diverticulitis(ARCD),accounting for 92.9%,and 11 cases of acute left-sided colonic diverticulitis(ALCD),accounting for 7.1%.③Among the patients with ARCD,142 cases(99.3%)complained of abdominal pain,29 cases(20.3%)had fever,44 cases(30.8%)had migratory right lower abdominal pain,and 125 cases(86.7%)had right lower abdominal pain.In the ALCD cases,10 cases(90.9%)had abdominal pain,5 cases(45.5%)had fever,3 cases(27.2%)had diarrhea,1 case(9.1%)had hematochezia,and 11 cases(100.0%)had pressure pain(including diffuse pressure pain)in the left abdomen by physical examination.④The differences between the non-recurrence group and the recurrence group in age,gender,abdominal pain,fever,hematochezia,diarrhea,nausea and vomiting,lesion location,WBC and NE%for the first time were not statistically significant(P>0.05).⑤There were 97 patients(63.0%)with stage 0,36 patients recurred after the treatment(recurrence rate 37.1%);There were 29 patients(18.8%)with stage 1A,6 patients(20.7%)recurred;There were 7 patients(4.6%)with stage 1B,4 patients(57.1%)recurred;There were 9 patients(5.8%)with stage 2A,5 patients(55.6%)recurred;There were 7 patients(4.6%)with stage 2B,3 patients(42.9%)recurred;There were 4 patients(2.6%)with stage 3,2 cases were treated by surgery and 1 case(25.0%)recurred;1 patient(0.6%)with stage 4 was surgically treated and did not recur.⑥The difference in WSES classification between the non-recurrence group and the recurrence group was not statistically significant(Z=-0.118,P>0.05).The recurrence group had a higher proportion of diverticular fecalith(23.6%vs.5.1%,χ^(2)=11.832,P=0.001)and the inflammation-related appendix(45.5%vs.10.1%,χ^(2)=25.163,P=0.000),and the difference was statistically significant(P<0.05).⑦The WSES classifications at the time of recurrence were not elevated in 42 cases,and the WSES classifications were elevated in 13 cases.Patients with fecalith in the diverticulum were more likely to have elevated WSES classification after the recurrence(69.2%vs.9.5%,χ^(2)=19.607,P=0.000),and the difference was statistically significant(P<0.05).There was no statistically significant difference in inflammation-related appendix between patients without elevated WSES classification and those with elevated WSES classification after the recurrence(47.6%vs.38.5%,χ^(2)=0.336,P>0.05).Conclusions Acute colonic diverticulitis is more common in males and predominantly in the patients under the age of 60.ARCD is more common and the clinical presentation is mainly right lower abdominal pain,which may manifest as migratory right lower abdominal pain.The recurrence rate in the patients with fecalith in the diverticulum or inflammation-related appendix was higher and the WSES classification is easy to increase after the recurrence in the patients with fecalith in the diverticulum.
作者
刘斯
孙玉佳
刘珵
汪波
熊辉
汪欣
Liu Si;Sun Yu-jia;Liu Cheng;Wang Bo;Xiong Hui;Wang Xin(Emergency Department,Peking University First Hospital,Beijing 100034,China)
出处
《中国急救医学》
CAS
CSCD
2022年第2期121-125,共5页
Chinese Journal of Critical Care Medicine
关键词
急性结肠憩室炎
临床特征
世界急诊外科学学会(WSES)分级
阑尾
粪石
复发率
急性右半结肠憩室炎(ARCD)
Acute colonic diverticulitis
Clinical characteristics
The World Society of Emergency Surgery(WSES)classification
Appendix
Fecalith
Recurrence rate
Acute right-sided colonic diverticulitis(ARCD)
