- 期刊
大腸憩室疾病文獻回顧
Diverticulosis and Diverticulitis: A Narrative Review
摘要
人體大腸負責吸收腸道中的水分，而隨著年紀的增加，大腸的腸壁逐漸變厚、容積減少，腸蠕動異常、或飲食中缺乏纖維、腸內壓力增加等，大腸內壁較脆弱的黏膜被擠壓到腸壁肌肉層外，形成凸出的囊袋稱為大腸憩室。根據研究超過60歲族群中約有50%有大腸憩室炎（diverticulosis）。當糞便掉入大腸憩室成為糞石會刺激周圍組織、引起腸道細菌感染，此時大腸會出現明顯發炎，稱為大腸憩室炎（diverticulitis）；臨床上僅約15－20%的大腸憩室症患者會出現大腸憩室炎。病人第一次感染通常不會有太嚴重的後遺症；不過若是反覆感染就可能發生大腸膿瘍或穿孔，會引發比較嚴重的出血與感染症狀，可能引起腹膜炎或全身性感染，此時有致命風險需要手術治療。而腹膜炎的主要表現是腹痛及發燒、畏寒，可能伴隨噁心、嘔吐、腹瀉或是便祕等輕微腸胃不適的症狀，嚴重者可能出現呼吸急促、寡尿、低血壓，甚至休克死亡；誘發腹膜炎的病因包括腹內臟器的急性穿孔與破裂例如：急性闌尾炎、消化性潰瘍、胃潰瘍等。
並列摘要
The colon is responsible for absorbing water in the human. With the increase of age, the wall of the colon gradually thickens, and the volume decreases. The intestinal peristalsis is abnormal which is consume about the low fiber diet and the intestinal pressure increases. The weaker mucosa of the lining of the large intestine is squeezed out of the muscular layer of the intestinal wall, and forming a bulging pouch called a large bowel diverticulum. According to research, about 50% of people over 60 years old have diverticulitis. When feces fall into the large intestine diverticulum and become feces, it will irritate surrounding tissues and induce intestinal bacterial infections. At the same time, the colon will become inflamed, which is called diverticulitis. Clinically only about 15-20% of patients with diverticulosis will developed into colorectal diverticulitis. The patient's first infection usually does not have serious sequelae. However, if repeated infection occurs, bowel abscess or perforation may occur, and will cause more severe bleeding and infections. Infections may cause peritonitis or sepsis, etc. At the same time there are risks of fatality requiring surgical involved. The main manifestations of peritonitis are abdominal pain, fever, chills, and may be accompanied by mild gastrointestinal symptoms such as nausea, vomiting, diarrhea or constipation. In some severe cases, oliguria, hypotension and even sepsis shock may also occur. The causes of peritonitis are included acute perforation and rupture of abdominal organs such as acute appendicitis, peptic ulcer, gastric ulcer, etc.