结肠憩室炎内外科治疗进展综述

Advances in the Medical and Surgical Management of Colonic Diverticulitis: A Comprehensive Review

摘要: 结肠憩室病是一种常见的结直肠疾病，其患病率随着年龄的增长显著增加，尤其在老年人群中更为普遍。当憩室发生急性或慢性炎症反应时，即称为憩室炎。结肠憩室炎是消化系统常见的疾病，近年来其临床管理策略得到了显著进展，持续更新的循证医学证据推动了从标准化治疗方案向个体化治疗方案的转变。本综述系统分析了近五年结肠憩室炎内外科治疗的重要临床研究、指南更新及循证医学进展。当前的治疗策略强调根据疾病的严重程度及患者的个体特征，采取个性化治疗方案。临床上常采用Hinchey分级或世界急诊外科学会(WSES)分级标准进行风险分层。基于此，对于无并发症的憩室炎(对应于Hinchey Ia级)，治疗趋势倾向于选择性不使用抗生素并在门诊进行管理；对于复杂病例(如Hinchey II~IV级)，则根据具体情况采取分阶段的治疗策略，包括经皮引流、腹腔镜手术或开腹手术等。微创技术在憩室炎治疗中的应用日益广泛，损伤控制策略在穿孔性憩室炎伴弥漫性腹膜炎(Hinchey III/IV级)中的应用显著改善了患者的预后。本综述旨在为临床医师提供最新的治疗决策依据。

Abstract: Colonic diverticulosis is a common colorectal disorder, with its prevalence significantly increasing with age, particularly in the elderly population. When diverticula become inflamed, either acutely or chronically, the condition is referred to as diverticulitis. Colonic diverticulitis is a frequently encountered digestive system disease, and its clinical management has seen considerable advancements in recent years. The continuously evolving body of evidence-based research has facilitated a shift from standardized treatment protocols to more individualized treatment strategies. This review systematically analyzes key clinical studies, guideline updates, and evidence-based progress in both the medical and surgical management of colonic diverticulitis over the past five years. Current therapeutic strategies emphasize personalized approaches, considering disease severity and individual patient characteristics. Clinical risk stratification tools, such as the Hinchey classification or the World Society of Emergency Surgery (WSES) grading system, are commonly employed to guide decision-making. Based on these classifications, for uncomplicated diverticulitis (corresponding to Hinchey stage Ia), the treatment trend favors selective non-antibiotic management in an outpatient setting. In complicated cases (e.g., Hinchey stage II~IV), a stepwise treatment approach is adopted, involving percutaneous drainage, laparoscopic surgery, or open surgery, depending on the specific clinical scenario. Minimally invasive techniques have been increasingly applied in the treatment of diverticulitis, and damage control strategies for perforated diverticulitis with diffuse peritonitis (Hinchey III/IV) have significantly improved patient outcomes. This review aims to provide clinicians with up-to-date, evidence-based guidance to inform treatment decision-making.