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Abstract：
BACKGROUND: This multicentre case-control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.
METHODS: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.
RESULTS: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23).
CONCLUSIONS: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking\'s role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.
METHODS: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.
RESULTS: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23).
CONCLUSIONS: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking\'s role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.
摘要：
背景：这项多中心病例对照研究旨在确定CT扫描HincheyIb-IIb和WSESIb-IIa憩室脓肿患者非手术治疗失败的危险因素。
方法：本研究包括一组首次出现CT诊断憩室脓肿的成年患者，所有患者均接受了初始非手术治疗,包括单独使用抗生素或联合经皮引流.根据非手术治疗的结果对队列进行分层，特别确定需要紧急手术干预的患者为治疗失败的患者。采用多变量logistic回归分析确定非手术治疗失败的独立危险因素。
结果：116例（27.04%）患者保守治疗失败。CT扫描Hinchey分类IIb(aOR2.54,95CI1.61;4.01,P<0.01),吸烟（aOR2.01，95CI1.24；3.25，P<0.01），脓肿内存在气泡(aOR1.59,95CI1.00;2.52,P=0.04)是失败的独立预测因子.在脓肿>5cm的患者亚组中，经皮穿刺引流与非手术治疗失败或成功的风险无关(aOR2.78,95CI-0.66;3.70,P=0.23).
结论：对于憩室脓肿，非手术治疗通常是有效的。吸烟作为治疗失败的独立危险因素的作用强调了在憩室疾病管理中需要有针对性的行为干预措施。IIbHinchey憩室炎患者，尤其是年轻的吸烟者，由于治疗失败和脓毒症进展的风险增加，需要警惕监测。对图像引导经皮引流的疗效的进一步研究应包括随机，多中心研究侧重于同质患者群体。
方法：本研究包括一组首次出现CT诊断憩室脓肿的成年患者，所有患者均接受了初始非手术治疗,包括单独使用抗生素或联合经皮引流.根据非手术治疗的结果对队列进行分层，特别确定需要紧急手术干预的患者为治疗失败的患者。采用多变量logistic回归分析确定非手术治疗失败的独立危险因素。
结果：116例（27.04%）患者保守治疗失败。CT扫描Hinchey分类IIb(aOR2.54,95CI1.61;4.01,P<0.01),吸烟（aOR2.01，95CI1.24；3.25，P<0.01），脓肿内存在气泡(aOR1.59,95CI1.00;2.52,P=0.04)是失败的独立预测因子.在脓肿>5cm的患者亚组中，经皮穿刺引流与非手术治疗失败或成功的风险无关(aOR2.78,95CI-0.66;3.70,P=0.23).
结论：对于憩室脓肿，非手术治疗通常是有效的。吸烟作为治疗失败的独立危险因素的作用强调了在憩室疾病管理中需要有针对性的行为干预措施。IIbHinchey憩室炎患者，尤其是年轻的吸烟者，由于治疗失败和脓毒症进展的风险增加，需要警惕监测。对图像引导经皮引流的疗效的进一步研究应包括随机，多中心研究侧重于同质患者群体。
