留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

1例慢性结肠憩室炎的循证诊疗

于子清 唐晓妍 吴斌 杨红

于子清, 唐晓妍, 吴斌, 杨红. 1例慢性结肠憩室炎的循证诊疗[J]. 协和医学杂志, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585
引用本文: 于子清, 唐晓妍, 吴斌, 杨红. 1例慢性结肠憩室炎的循证诊疗[J]. 协和医学杂志, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585
YU Ziqing, TANG Xiaoyan, WU Bin, YANG Hong. Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585
Citation: YU Ziqing, TANG Xiaoyan, WU Bin, YANG Hong. Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585

1例慢性结肠憩室炎的循证诊疗

doi: 10.12290/xhyxzz.2022-0585
基金项目: 

国家自然科学基金 81970495

北京市自然科学基金 7202161

首都卫生发展科研专项 2022-2-4014

中国医学科学院医学与健康科技创新工程 2021-I2M-1-001

详细信息
    通讯作者:

    杨红, E-mail: yangh@pumch.cn

  • 中图分类号: R574.62

Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report

Funds: 

National Natural Science Foundation of China 81970495

Natural Science Foundation of Beijing 7202161

The Capital Health Research and Development of Special 2022-2-4014

CAMS Innovation Fund for Medical Sciences 2021-I2M-1-001

More Information
  • 摘要: 结肠憩室炎是一种十分常见的胃肠道疾病,可为急性或慢性病程。本文报道1例慢性结肠憩室炎患者的诊疗经过。该患者临床表现不典型,影像学检查示占位性病变可能性大,PET/CT示代谢增高灶,急性期结肠镜检查可见黏膜隆起、病理回报为炎症,但仍需与结直肠癌、炎症性肠病进行鉴别。综合考虑后予以随访观察的建议,并最终明确诊断。该患者的诊治经过体现了循证医学在疾病诊断与治疗中的重要意义。
    专家点评:
    中国医学科学院北京协和医院消化内科  杨红教授
    结肠憩室炎反复或慢性持续发作导致的炎症反应、肉芽组织增生与部分CRC患者的表现存在很大程度的相似之处,加上临床症状缺乏特异性,导致二者的鉴别诊断存在一定困难,影响后续治疗决策的制订。该患者为老年女性、慢性病程,外院检查无法除外乙状结肠占位性病变,此次住院评估后考虑乙状结肠病灶暂无恶变证据,嘱患者定期随访。在为期1年的随访过程中患者肠壁增厚、乙状结肠隆起明显好转,结肠憩室炎得以明确诊断。循证医学引入中国已有20余年并得到了广泛应用,其核心思想是予以患者关照和尊重,将循证医学融入日常的临床工作中无疑会为患者带来便利。在综合最佳证据、明确证据可信度与权衡获益及风险后,基于循证医学证据对该患者的病情作出个体化评估,有助于明确诊断思路并厘清后续治疗方法、避免有创操作,为患者提供最优的诊疗路径。
    作者贡献:于子清负责收集资料、撰写论文;吴斌、唐晓妍负责审阅论文;杨红负责修订论文。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  结肠镜检查示乙状结肠局部肿胀,肠腔轻中度狭窄,黏膜表面糜烂(2021年6月18日)

    图  2  结肠CT示乙状结肠局部结节状突起(箭头,2021年6月28日)

    图  3  结肠镜检查示结肠多发小憩室(2022年7月8日)

    表  1  不同检查方式对结肠憩室炎诊断价值比较

    第一作者(年份) 检查方式 样本(n) Se(%, 95% CI) Sp(%, 95% CI) LR+(95% CI) LR-(95% CI)
    Qaseem等[6],Balk等[7](2022年) CT 684 94(97~97) 99(90~99.9) 78.4(8.7~706.6) 0.06(0.03~0.13)
    Laméris等[8](2008年) 超声 630 92(80~97) 90(82~95) 9.6(5.0~18.6) 0.09(0.04~0.23)
    Andeweg等[9](2014年),Liljegren等[10](2007年) CT 684 95(91~97) 96(90~100) 30.62(16.07~58.36) 0.10(0.07~0.15)
    Andeweg等[9](2014年) 超声 698 90(76~98) 90(86~94) 12.83(7.42~22.19) 0.12(0.08~0.17)
    Andeweg等[9](2014年) MRI 57 98 70~78 4.40(1.30~14.96) 0.03(0.004~0.20)
    Se:灵敏度;Sp:特异度;LR+:阳性似然比;LR-:阴性似然比
    下载: 导出CSV

    表  2  结肠憩室炎患者后续罹患CRC的风险

    第一作者(年份) 样本(n) 结肠憩室炎发生癌前病变的风险(OR) 结肠憩室炎发生CRC的风险(%,95% CI) 单纯性结肠憩室炎发生CRC的风险(%,95% CI) 复杂性结肠憩室炎发生CRC的风险(%,95% CI) 复杂性/单纯性憩室炎发生CRC的风险比较(RR,95% CI)
    Qaseem等[13],Balk等[14](2022年) 1721/2635 0.62 - - - -
    Koo等[15](2020年) 31 741 - 1.67(1.24~2.14) 1.22(0.63~1.97) 6.14(3.20~9.82) 5.033(3.714~7.930)
    Sharma等[16](2014年) 1970 - 1.6(0.9~2.8) 0.7(0.3~1.4) 10.8(5.2~21.0) -
    de Vries等[17](2014年) 2490 - - 1.16(0.72~1.9) - -
    CRC: 结直肠癌;-:无相关数据
    下载: 导出CSV
  • [1] Stollman N, Raskin JB. Diverticular disease of the colon[J]. Lancet, 2004, 363: 631-639. doi:  10.1016/S0140-6736(04)15597-9
    [2] Etzioni DA, Mack TM, Beart RW, et al. Diverticulitis in the United States: 1998—2005: changing patterns of disease and treatment[J]. Ann Surg, 2009, 249: 210-217. doi:  10.1097/SLA.0b013e3181952888
    [3] Gryspeerdt S, Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography[J]. Abdom Imaging, 2012, 37: 1101-1109. doi:  10.1007/s00261-012-9858-6
    [4] Goh V, Halligan S, Taylor SA, et al. Differentiation between diverticulitis and colorectal cancer: quantitative CT perfusion measurements versus morphologic criteria--initial experience[J]. Radiology, 2007, 242: 456-62. doi:  10.1148/radiol.2422051670
    [5] Tursi A, Elisei W, Giorgetti GM, et al. Inflammatory manifestations at colonoscopy in patients with colonic diverticular disease[J]. Aliment Pharmacol Ther, 2011, 33: 358-365. doi:  10.1111/j.1365-2036.2010.04530.x
    [6] Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al. Clinical Guidelines Committee of the American College of Physicians. Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians[J]. Ann Intern Med, 2022, 175: 399-415. doi:  10.7326/M21-2710
    [7] Balk EM, Adam GP, Bhuma MR, et al. Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis: A Systematic Review[J]. Ann Intern Med, 2022, 175: 379-387. doi:  10.7326/M21-1645
    [8] Laméris W, van Randen A, Bipat S, et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy[J]. Eur Radiol, 2008, 18: 2498-2511. doi:  10.1007/s00330-008-1018-6
    [9] Andeweg CS, Wegdam JA, Groenewoud J, et al. Toward an evidence-based step-up approach in diagnosing diverticulitis[J]. Scand J Gastroenterol, 2014, 49: 775-784. doi:  10.3109/00365521.2014.908475
    [10] Liljegren G, Chabok A, Wickbom M, et al. Acute colonic diverticulitis: a systematic review of diagnostic accuracy[J]. Colorectal Dis, 2007, 9: 480-488. doi:  10.1111/j.1463-1318.2007.01238.x
    [11] Jerjen F, Zaidi T, Chan S, et al. Magnetic Resonance Imaging for the diagnosis and management of acute colonic diverticulitis: a review of current and future use[J]. J Med Radiat Sci, 2021, 68: 310-319. doi:  10.1002/jmrs.458
    [12] Lurz M, Gazis A, Hanschke S, et al. Value of high-field magnetic resonance imaging for diagnosis and classification of acute colonic diverticulitis[J]. Int J Colorectal Dis, 2022, 37: 201-207. doi:  10.1007/s00384-021-04045-y
    [13] Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al. Clinical Guidelines Committee of the American College of Physicians. Colonoscopy for Diagnostic Evaluation and Interventions to Prevent Recurrence After Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians[J]. Ann Intern Med, 2022, 175: 416-431. doi:  10.7326/M21-2711
    [14] Balk EM, Adam GP, Cao W, et al. Evaluation and Management After Acute Left-Sided Colonic Diverticulitis: A Systematic Review[J]. Ann Intern Med, 2022, 175: 388-398. doi:  10.7326/M21-1646
    [15] Koo CH, Chang JHE, Syn NL, et al. Systematic Review and Meta-analysis on Colorectal Cancer Findings on Colonic Evaluation After CT-Confirmed Acute Diverticulitis[J]. Dis Colon Rectum, 2020, 63: 701-709. doi:  10.1097/DCR.0000000000001664
    [16] Sharma PV, Eglinton T, Hider P, et al. Systematic review and meta-analysis of the role of routine colonic evaluation after radiologically confirmed acute diverticulitis[J]. Ann Surg, 2014, 259: 263-272. doi:  10.1097/SLA.0000000000000294
    [17] de Vries HS, Boerma D, Timmer R, et al. Routine colonoscopy is not required in uncomplicated diverticulitis: a systematic review[J]. Surg Endosc, 2014, 28: 2039-2047. doi:  10.1007/s00464-014-3447-4
    [18] Tehranian S, Klinge M, Saul M, et al. Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy[J]. Gastrointest Endosc, 2020, 91: 634-640. doi:  10.1016/j.gie.2019.08.044
    [19] Jin-Dominguez F, Mansoor E, Panhwar MS, et al. Epidemiology of Diverticulitis and Prevalence of First-Ever Colorectal Cancer Postdiverticulitis in Adults in the United States: A Population-Based National Study[J]. Dis Colon Rectum, 2021, 64: 181-189. doi:  10.1097/DCR.0000000000001837
    [20] Fugazzola P, Ceresoli M, Coccolini F, et al. The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for dia-gnosis and treatment of acute left colonic diverticulitis in the elderly[J]. World J Emerg Surg, 2022, 17: 5. doi:  10.1186/s13017-022-00408-0
    [21] Pemberton OH, Lamont JT, Grover S. Clinical manifesta-tions and diagnosis of acute diverticulitis in adults[EB/QL]. (2022-07-14)[2022-10-09]. https://www.upto-date.com/contents/clinical-manifestations-and-diagnosis-of-acute-diverticulitis-in-adults.
    [22] Francis NK, Sylla P, Abou-Khalil M, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice[J]. Surg Endosc, 2019, 33: 2726-2741. doi:  10.1007/s00464-019-06882-z
    [23] Salzman H, Lillie D. Diverticular disease: diagnosis and treatment[J]. Am Fam Physician, 2005, 72: 1229-1234.
  • 加载中
图(3) / 表(2)
计量
  • 文章访问数:  2244
  • HTML全文浏览量:  625
  • PDF下载量:  80
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-10-09
  • 录用日期:  2022-12-14
  • 刊出日期:  2023-01-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!