结肠憩室炎患者的临床治疗效果（附94例报告）

A retrospective study of 94 patients with colonic diverticulitis

摘要:

目的 评价内科抗生素治疗、内镜微创治疗和外科手术治疗用于结肠憩室炎的临床疗效。方法 回顾性分析重庆医科大学附属大学城医院和重庆医科大学附属第一医院2022年1月－2025年6月因腹痛等症状收治入院的94例结肠憩室炎患者的临床资料，将其分为：单纯性结肠憩室炎组（单纯憩室炎组，43例）和结肠憩室炎伴腹膜炎组（伴腹膜炎组，51例）。再根据不同治疗方式进行亚分组，分为：内科抗生素治疗组（保守治疗组）、内镜微创治疗组（内镜下憩室粪石取出联合钛夹止血，简称内镜治疗组）和外科手术组（部分结肠切除，简称外科治疗组）。统计分析各组患者的临床特征、住院时间、住院费用和临床疗效等。结果 伴腹膜炎组腹痛发生率较单纯憩室炎组高，年龄较单纯憩室炎组小。单纯憩室炎组中，内科抗生素治疗31例，内镜微创治疗11例，外科手术1例，3种治疗方式临床疗效、短期复发和并发症比较，差异均无统计学意义（P > 0.05）。伴腹膜炎组中，采用上述3种治疗，有效率均为100.00%，3种治疗方式的并发症和3个月内复发率比较，差异均无统计学意义（P > 0.05）；保守治疗组中位数住院时长为6.00 d，内镜治疗组为5.50 d，手术治疗组为8.00 d；手术治疗组住院费用明显高于保守治疗组和内镜治疗组。结论 单纯憩室炎组采取内科抗生素治疗的成功率高。伴腹膜炎组，3种治疗方法均有较好的临床疗效，但外科手术费用较高，住院时间较长，且存在并发症。

Abstract:

Objective To evaluate the therapeutic efficacy of medical antibiotic therapy, endoscopic minimally invasive treatment, and surgical intervention in patients with colonic diverticulitis.Methods A retrospective analysis was performed of 94 patients with colonic diverticulitis from January 2022 to June 2025 due to symptoms such as abdominal pain. Patients were categorized into a simple diverticulitis group (n = 43) and a colonic diverticulitis with peritonitis group (peritonitis group, n = 51). According to treatment modality, patients were further divided into a medical antibiotic treatment group (conservative treatment group), an endoscopic minimally invasive treatment group (endoscopic fecalith removal and hemoclip placement for hemostasis, endoscopic treatment group), and a surgical treatment group (partial colectomy, surgical treatment group). Clinical characteristics, length of hospital stay, hospitalization costs, and treatment outcomes were compared among groups.Results The incidence of abdominal pain was higher and the age was younger in the peritonitis group compared with the simple diverticulitis group. In the simple diverticulitis group, 31 received conservative antibiotic therapy, 11 underwent endoscopic minimally invasive treatment, and 1 underwent surgical resection. No significant differences were observed among the three treatment modalities in terms of therapeutic efficacy, short-term recurrence, or complication rates (P > 0.05). In the peritonitis group, all three treatment modalities were applied, and the effective rate was 100.00% in all three groups. There were no statistically significant differences in the incidence of complications or the recurrence rate within 3 months among the three treatment groups (P > 0.05); the median length of hospital stay was 6.00 days in the conservative treatment group, 5.50 days in the endoscopic treatment group, and 8.00 days in the surgical treatment group; hospitalization costs were significantly higher in the surgical treatment group than in the conservative and endoscopic treatment groups.Conclusion Medical antibiotic therapy is effective for patients with simple colonic diverticulitis, with a high treatment success rate. For patients with colonic diverticulitis complicated by peritonitis, both medical antibiotic therapy and endoscopic minimally invasive treatment involving fecalith removal and titanium clip closure achieve favorable clinical outcomes comparable to surgical treatment. However, surgical treatment is associated with higher hospitalization costs, longer hospital stays, and a risk of complications.