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JAMA：慢性及复发性乙状结肠憩室炎不推荐抗生素和手术

2014-01-25 佚名 dxy

复发性乙状结肠憩室炎抗生素
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乙状结肠憩室炎为常见疾病，密歇根州大学附属医院结直肠外科Morris教授等对乙状结肠憩室炎的病因、自然史及近期指南中治疗方法的改变进行了一项系统回顾研究，结果发表在2014年1月15日的JAMA杂志上。 研究检索了MEDLINE、Cochrane数据库中，2000年1月1日至2013年3月31日发表的有关憩室炎诊断和治疗的英文文章。检索关键词为：病理生理、自然史、药物治疗、手术适应症，并排除小规

乙状结肠憩室炎为常见疾病，密歇根州大学附属医院结直肠外科Morris教授等对乙状结肠憩室炎的病因、自然史及近期指南中治疗方法的改变进行了一项系统回顾研究，结果发表在2014年1月15日的JAMA杂志上。

研究检索了MEDLINE、Cochrane数据库中，2000年1月1日至2013年3月31日发表的有关憩室炎诊断和治疗的英文文章。检索关键词为：病理生理、自然史、药物治疗、手术适应症，并排除小规模病例研究和基于2000年以前研究数据的文章。

研究共纳入80篇文章及186篇参考文献，并根据美国心脏病协会工作小组的实践指南对证据进行分级，将推荐意见根据治疗效果进行分类。

现行标准下急性憩室炎临床研究结果

分析发现，憩室炎的病理生理与肠道动力学改变、肠腔内压力增加及结肠内环境紊乱有关。其中涉及憩室炎与炎症性肠病、肠易激综合症共性的研究表明，这些疾病之间具有相关性，但并无因果关系。

简单的憩室炎其自然发展史通常表现为良性。一项包括2366名急性憩室炎住院患者的队列研究表明，仅有13.3%的患者复发，其中3.9%的患者复发两次。脓毒性腹膜炎的发病率低于预期，且在复发时并不增加。

有关病人临床结局的研究表明，20-35%非手术治疗的憩室炎患者遗留有慢性腹痛，而这一数据在手术治疗患者中仅为5-25%。

随机临床试验及队列研究表明，抗生素及纤维素的作用并不像既往认为的那样有效，而美沙拉嗪却可能有效。同时，研究结论不推荐手术治疗慢性憩室炎。
因此，作者指出，与以往相比，抗生素或手术治疗对慢性/复发性憩室炎的疗效已日益减弱。

原文出处

Morris AM, Regenbogen SE, Hardiman KM, Hendren S.Sigmoid diverticulitis: a systematic review.JAMA. 2014 Jan 15

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    2015-08-06 hlycom3356

    期待有更多研究

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=35083, encodeId=73f63508326, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:07:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1909554, encodeId=22c019095545c, content=<a href='/topic/show?id=8f1f42518d8' target=_blank style='color:#2F92EE;'>#复发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42518, encryptionId=8f1f42518d8, topicName=复发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Mon Aug 11 21:34:00 CST 2014, time=2014-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391432, encodeId=2ff41391432fa, content=<a href='/topic/show?id=b5be53e91fc' target=_blank style='color:#2F92EE;'>#憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53791, encryptionId=b5be53e91fc, topicName=憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522704, encodeId=5d7d1522e0495, content=<a href='/topic/show?id=14d853e8918' target=_blank style='color:#2F92EE;'>#憩室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53789, encryptionId=14d853e8918, topicName=憩室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33b211483971, createdName=zutt, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523800, encodeId=b53815238005f, content=<a href='/topic/show?id=7170e87563e' target=_blank style='color:#2F92EE;'>#结肠憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78756, encryptionId=7170e87563e, topicName=结肠憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e5311558208, createdName=guojianrong, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7107, encodeId=8ec7e10724, content=手术治疗患者慢性腹痛比较少，也是有利的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e5288766, createdName=caoxie, createdTime=Sun Jan 26 10:14:00 CST 2014, time=2014-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7098, encodeId=db79e098d9, content=各类研究让人无所适从了，该信谁的呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=treeing, createdTime=Sat Jan 25 21:40:00 CST 2014, time=2014-01-25, status=1, ipAttribution=)]
    2014-08-11 hb2008ye

    #复发性#

    0

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    2014-01-27 zhouqu_8

    #憩室炎#

    0

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    2014-01-27 zutt

    #憩室#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=35083, encodeId=73f63508326, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:07:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1909554, encodeId=22c019095545c, content=<a href='/topic/show?id=8f1f42518d8' target=_blank style='color:#2F92EE;'>#复发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42518, encryptionId=8f1f42518d8, topicName=复发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Mon Aug 11 21:34:00 CST 2014, time=2014-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391432, encodeId=2ff41391432fa, content=<a href='/topic/show?id=b5be53e91fc' target=_blank style='color:#2F92EE;'>#憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53791, encryptionId=b5be53e91fc, topicName=憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522704, encodeId=5d7d1522e0495, content=<a href='/topic/show?id=14d853e8918' target=_blank style='color:#2F92EE;'>#憩室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53789, encryptionId=14d853e8918, topicName=憩室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33b211483971, createdName=zutt, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523800, encodeId=b53815238005f, content=<a href='/topic/show?id=7170e87563e' target=_blank style='color:#2F92EE;'>#结肠憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78756, encryptionId=7170e87563e, topicName=结肠憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e5311558208, createdName=guojianrong, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7107, encodeId=8ec7e10724, content=手术治疗患者慢性腹痛比较少，也是有利的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e5288766, createdName=caoxie, createdTime=Sun Jan 26 10:14:00 CST 2014, time=2014-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7098, encodeId=db79e098d9, content=各类研究让人无所适从了，该信谁的呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=treeing, createdTime=Sat Jan 25 21:40:00 CST 2014, time=2014-01-25, status=1, ipAttribution=)]
    2014-01-27 guojianrong

    #结肠憩室炎#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=35083, encodeId=73f63508326, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:07:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1909554, encodeId=22c019095545c, content=<a href='/topic/show?id=8f1f42518d8' target=_blank style='color:#2F92EE;'>#复发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42518, encryptionId=8f1f42518d8, topicName=复发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Mon Aug 11 21:34:00 CST 2014, time=2014-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391432, encodeId=2ff41391432fa, content=<a href='/topic/show?id=b5be53e91fc' target=_blank style='color:#2F92EE;'>#憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53791, encryptionId=b5be53e91fc, topicName=憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522704, encodeId=5d7d1522e0495, content=<a href='/topic/show?id=14d853e8918' target=_blank style='color:#2F92EE;'>#憩室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53789, encryptionId=14d853e8918, topicName=憩室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33b211483971, createdName=zutt, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523800, encodeId=b53815238005f, content=<a href='/topic/show?id=7170e87563e' target=_blank style='color:#2F92EE;'>#结肠憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78756, encryptionId=7170e87563e, topicName=结肠憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e5311558208, createdName=guojianrong, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7107, encodeId=8ec7e10724, content=手术治疗患者慢性腹痛比较少，也是有利的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e5288766, createdName=caoxie, createdTime=Sun Jan 26 10:14:00 CST 2014, time=2014-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7098, encodeId=db79e098d9, content=各类研究让人无所适从了，该信谁的呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=treeing, createdTime=Sat Jan 25 21:40:00 CST 2014, time=2014-01-25, status=1, ipAttribution=)]
    2014-01-26 caoxie

    手术治疗患者慢性腹痛比较少，也是有利的嘛

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=35083, encodeId=73f63508326, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 23:07:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1909554, encodeId=22c019095545c, content=<a href='/topic/show?id=8f1f42518d8' target=_blank style='color:#2F92EE;'>#复发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42518, encryptionId=8f1f42518d8, topicName=复发性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Mon Aug 11 21:34:00 CST 2014, time=2014-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391432, encodeId=2ff41391432fa, content=<a href='/topic/show?id=b5be53e91fc' target=_blank style='color:#2F92EE;'>#憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53791, encryptionId=b5be53e91fc, topicName=憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522704, encodeId=5d7d1522e0495, content=<a href='/topic/show?id=14d853e8918' target=_blank style='color:#2F92EE;'>#憩室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53789, encryptionId=14d853e8918, topicName=憩室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33b211483971, createdName=zutt, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523800, encodeId=b53815238005f, content=<a href='/topic/show?id=7170e87563e' target=_blank style='color:#2F92EE;'>#结肠憩室炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78756, encryptionId=7170e87563e, topicName=结肠憩室炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e5311558208, createdName=guojianrong, createdTime=Mon Jan 27 02:34:00 CST 2014, time=2014-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7107, encodeId=8ec7e10724, content=手术治疗患者慢性腹痛比较少，也是有利的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e5288766, createdName=caoxie, createdTime=Sun Jan 26 10:14:00 CST 2014, time=2014-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=7098, encodeId=db79e098d9, content=各类研究让人无所适从了，该信谁的呢？, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=treeing, createdTime=Sat Jan 25 21:40:00 CST 2014, time=2014-01-25, status=1, ipAttribution=)]
    2014-01-25 treeing

    各类研究让人无所适从了，该信谁的呢？

    0

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