大腸憩室疾病之最新進展

Recent Advances in Colon Diverticular Disease

簡乃宣(Nai-Hsuan Chien) ； 李嘉龍(Chia-Long Lee)

《內科學誌》 25卷4期 (2014/08) Pp. 238-249

https://doi.org/10.6314/JIMT.2014.25(4).02

摘要

憩室疾病是臨床上常見且古老的問題，近年隨著年齡老化與生活西化，憩室疾病發生率與重要性也持續上升，我們回顧了許多最近的研究與臨床報告，更新了許多傳統的思維，包含了高纖食物無法預防憩室疾病的發生、種子類食物不會引發憩室炎、電腦斷層的廣泛應用可以幫助疾病嚴重程度的分級、益生菌與抗發炎藥物的使用可幫助憩室炎的症狀控制、放生素的使用在無併發症的憩室炎上可趨於保守等等，另外多篇報告也指出憩室炎的復發率與復發嚴重度並沒有傳統認為的厲害，因此目前共識不再建議預防性手術使用在復發性憩室炎患者身上。對於有腹內膿瘍或是腸破裂徵象的病人，因其晚期併發症較多，而較常進行手術治療，至於腹腔鏡手術的使用，與開刀中使用何種術式（Hartmann procedure or primary anastomosis），目前成未定論，需視病人的狀況做個別的規劃。

關鍵字

憩室疾病 ； 憩室炎 ； Modified Hinchey分類 ； Kaiser分類 ； 復發與預防性手術 ； 高纖食物

並列摘要

Diverticular disease is a popular and old problem. The incidence and importance also rise due to the aging and occidentalized population. We review recent studies and clinical data, and some concepts are different and updated. High fiber diet has no evidence in prevention. The seed would not induce the diverticulitis. The abdominal CT could give us more information for the severity classification. The usage of antibiotics could be more conservative in uncomplicated diverticulitis. The recurrent rate and severity are not as high as our estimation, so preventive operations for recurrence are not suggested any longer. Probiotics and anti-inflammatory medication have some benefit in the symptoms control. If the patients have abscess, pneumoperitoneum, or other perforation sign, the operations are more likely to perform due to the more late complication. The choices of laparoscope use or procedure method (Hartmann procedure or primary anastomosis) are still controversial and should depend on the patient condition.

並列關鍵字

Diverticular disease ； Diverticulitis ； Modified hinchey classification ； Kaiser classification ； Recurrence and elective surgery ； High fiber diet