急性结肠憩室炎132例临床特点分析

Clinical characteristics of 132 patients with acute colonic diverticulitis

目的探讨急性结肠憩室炎的临床特点.方法回顾性分析2007年1月-2017年12月该院收治的资料完整且经腹部CT、结肠镜和/或手术确诊的急性结肠憩室炎132例患者的临床资料.结果男89例,女43例,男女比例为2.1:1.0,发病年龄(51.8±13.1)岁;急性单纯性结肠憩室炎119例(90.2%),急性复杂性结肠憩室炎13例(9.8%);发病部位:盲肠升结肠82例(62.1%),乙状结肠23例(17.4%),降结肠16例(12.1%),横结肠8例(6.1%),同时累及两个部位者3例(2.3%);主要症状:腹痛132例(100.0%),发热117例(88.6%),腹部压痛132例(100.0%);外周血白细胞计数(WBC)升高者103例(78.0%),WBC计数(15.8±5.1)×109/L,C反应蛋白(CRP)升高者124例(93.9%),CRP数值(34.1±15.3)mg/L;所有患者均行腹部CT检查,有结肠壁增厚表现者124例(93.9%),结肠周围脂肪组织密度增高者78例(59.1%);119例急性单纯性憩室炎患者均经静脉输注抗生素后好转,13例急性复杂性憩室炎患者中,3例经单纯静脉输注抗生素后好转,5例单纯腹腔脓肿和2例腹腔脓肿伴腹腔积液者静脉输注抗生素,同时行腹腔引流管引流后好转,2例腹腔游离气体及1例腹腔脓肿并瘘管形成、腹腔积液患者行开腹手术治疗后好转,在院期间无死亡病例.结论急性结肠憩室炎好发于中老年男性,常见临床表现为腹痛、发热、腹部压痛,腹部增强CT在其诊断及病情评估中起重要作用,大部分患者无并发症,预后良好.

Objective To investigate the clinical characteristics of acute colonic diverticulitis. Methods Clinical records of 132 cases defined as acute colonic diverticulitis by abdominal CT, colonoscopy and/or surgery, hospitalized from January 2007 to December 2017 were analyzed retrospectively. Results Among the 132 cases, there were 89 male and 43 female cases (male : female 2.1 ∶ 1.0), with a mean age of (51.8 ± 13.1) years old. A total of 119 cases (90.2%) were diagnosed as uncomplicated acute colonic diverticulitis, while 13 cases (9.8%) as complicated acute colonic diverticulitis. The involving locations included cecum and ascending colon in 82 cases (62.1%), sigmoid colon in 23 cases (17.4%), descending colon in 16 cases (12.1%), transverse colon in 8 cases (6.1%), and two parts of the colon in 3 cases (2.3%). Main clinical symptoms included abdominal pain and tenderness in 132 cases (100.0%), and fever in 117 cases (88.6%). WBC increased in 103 cases (78.0%) with an average number of (15.8 ± 5.1)×109/L. CRP increased in 124 cases (93.9%) with an average value of (34.1 ± 15.3) mg/L. There were 124 cases (93.9%) with thickening of the colon wall and 78 cases (59.1%) with higher peripheral fat tissue density in contrast-enhanced CT. All uncomplicated cases were treated by intravenous antibiotics and improved. Among 13 cases of complicated cases, 3 patients treated by intravenous antibiotics alone and improved, 5 patients with abdominal abscess alone and 2 patients with both abdominal abscess and ascites improved by intravenous antibiotics and drainage of abdominal drainage tube. 2 patients with free intraperitoneal gas and 1 patient with abdominal abscess, fistula and ascites underwent laparotomy and improved. No one died in hospital. Conclusion Acute colonic diverticulitis occurs in middle-aged and old men. The most common clinical manifestations were abdominal pain, abdominal tenderness and fever. Abdominal contrast-enhanced CT plays an important role in diagnosis and assessment of the disease. Most of the patients had a better prognosis with no complications.