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Abstract：
OBJECTIVE: Diverticular abscess is a common manifestation of acute complicated diverticulitis. We aimed to analyze the clinical course of patients with diverticular abscess initially treated conservatively.
METHODS: All patients with diverticular abscess undergoing elective or urgent/emergency surgery from October 2004 to October 2022 were identified from our institutional database. Depending on the abscess size, patients were divided into group A (≤ 3 cm) and group B (> 3 cm). Conservative treatment failure was defined as clinical deterioration, persistent or recurrent abscess, or urgent/emergency surgery. Baseline characteristics and short-term perioperative outcomes were recorded and compared between both groups. Uni- and multivariate analyses were conducted to identify determinants of conservative treatment failure and overall ostomy formation.
RESULTS: A total of 105 patients were enrolled into group A (n = 73) and group B (n = 32). Uni- and multivariate analyses revealed abscess size as the only significant factor of conservative therapy failure [OR 9.904; p < 0.0001], while overall ostomy formation was significantly affected by an increased body mass index (BMI) [OR 1.366; p = 0.026]. There were no significant differences in perioperative outcome with the exception of a longer total hospital stay in patients managed with abscess drainage compared to antibiotics alone prior surgery in group B (p = 0.045).
CONCLUSIONS: Abscess diameter > 3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. In this subgroup, the choice between primary drainage and antibiotics does not appear to influence outcome at the cost of prolonged hospital stay after drainage insertion.
METHODS: All patients with diverticular abscess undergoing elective or urgent/emergency surgery from October 2004 to October 2022 were identified from our institutional database. Depending on the abscess size, patients were divided into group A (≤ 3 cm) and group B (> 3 cm). Conservative treatment failure was defined as clinical deterioration, persistent or recurrent abscess, or urgent/emergency surgery. Baseline characteristics and short-term perioperative outcomes were recorded and compared between both groups. Uni- and multivariate analyses were conducted to identify determinants of conservative treatment failure and overall ostomy formation.
RESULTS: A total of 105 patients were enrolled into group A (n = 73) and group B (n = 32). Uni- and multivariate analyses revealed abscess size as the only significant factor of conservative therapy failure [OR 9.904; p < 0.0001], while overall ostomy formation was significantly affected by an increased body mass index (BMI) [OR 1.366; p = 0.026]. There were no significant differences in perioperative outcome with the exception of a longer total hospital stay in patients managed with abscess drainage compared to antibiotics alone prior surgery in group B (p = 0.045).
CONCLUSIONS: Abscess diameter > 3 cm is not just an arbitrary chosen cut-off value for drainage placement but has a prognostic impact on medical treatment failure in patients with complicated acute diverticulitis. In this subgroup, the choice between primary drainage and antibiotics does not appear to influence outcome at the cost of prolonged hospital stay after drainage insertion.
摘要：
目的：憩室脓肿是急性复杂性憩室炎的常见表现。我们旨在分析最初保守治疗的憩室脓肿患者的临床过程。
方法：所有2004年10月至2022年10月接受择期或紧急/急诊手术的憩室脓肿患者均来自我们的机构数据库。根据脓肿的大小,将患者分为A组(≤3cm)和B组(>3cm)。保守治疗失败定义为临床恶化，持续性或复发性脓肿，或紧急/紧急手术。记录并比较两组的基线特征和短期围手术期结果。进行单因素和多因素分析以确定保守治疗失败和整体造口形成的决定因素。
结果：共105例患者被纳入A组（n=73）和B组（n=32）。单因素和多因素分析显示脓肿大小是保守治疗失败的唯一重要因素[OR9.904;p<0.0001],而总体造口术的形成受到体重指数(BMI)增加的显著影响[OR1.366;p=0.026].与B组单独手术前的抗生素相比，脓肿引流治疗的患者的总住院时间更长，围手术期结果无显着差异（p=0.045）。
结论：脓肿直径>3cm不仅是引流放置的任意选择的临界值，而且对并发急性憩室炎患者的药物治疗失败具有预后影响。在这个子群中,以引流后住院时间延长为代价,选择初级引流和抗生素似乎不会影响结局.
方法：所有2004年10月至2022年10月接受择期或紧急/急诊手术的憩室脓肿患者均来自我们的机构数据库。根据脓肿的大小,将患者分为A组(≤3cm)和B组(>3cm)。保守治疗失败定义为临床恶化，持续性或复发性脓肿，或紧急/紧急手术。记录并比较两组的基线特征和短期围手术期结果。进行单因素和多因素分析以确定保守治疗失败和整体造口形成的决定因素。
结果：共105例患者被纳入A组（n=73）和B组（n=32）。单因素和多因素分析显示脓肿大小是保守治疗失败的唯一重要因素[OR9.904;p<0.0001],而总体造口术的形成受到体重指数(BMI)增加的显著影响[OR1.366;p=0.026].与B组单独手术前的抗生素相比，脓肿引流治疗的患者的总住院时间更长，围手术期结果无显着差异（p=0.045）。
结论：脓肿直径>3cm不仅是引流放置的任意选择的临界值，而且对并发急性憩室炎患者的药物治疗失败具有预后影响。在这个子群中,以引流后住院时间延长为代价,选择初级引流和抗生素似乎不会影响结局.
