一項全國數(shù)據(jù)庫分析顯示，擇期結(jié)腸切除術(shù)的轉(zhuǎn)歸因適應(yīng)癥而異，憩室病的風(fēng)險和費用更高。在校正其他因素后，與接受相同的結(jié)腸切除術(shù)治療結(jié)腸癌的患者相比，憩室病患者術(shù)后死亡、感染及需要進行造瘺術(shù)的可能性增加67%～90%，該項結(jié)果在線發(fā)表于《Archives of Surgery》雜志上。

　　研究者分析納入了全國住院患者樣本2003～2009年紀錄的78879名進行降結(jié)腸擇期結(jié)腸切除術(shù)或結(jié)腸次全切除術(shù)治療憩室?。?1%）、結(jié)腸癌（43%）或IBD（6%）的成人。

　　結(jié)直腸癌患者的未校正死亡率最高（1.22%），他們的平均共病評分較高。未校正死亡率顯著高于憩室病和IBD患者（0.44%和0.85%）。結(jié)腸切除術(shù)治療憩室病的未校正術(shù)后感染率也是最低的（10.39%對IBD的15.40%和結(jié)腸癌的11.29%，P值均<0.001）。

　　但是在校正年齡、性別、人種、住院年數(shù)和共病后，結(jié)果發(fā)生了變化。結(jié)腸切除術(shù)治療憩室病與結(jié)腸癌的校正比值比對比如下（所有P值均在0.03到<0.001之間）：院內(nèi)死亡率1.90，術(shù)后感染1.67，出血1.71，并發(fā)急性心肌梗死5.33，卒中或膿毒癥1.96，腎衰竭2.61，肺功能受損2.49，血栓栓塞并發(fā)癥1.58，術(shù)中進行造瘺術(shù)1.87。

　　可能的解釋包括，由于既往炎癥導(dǎo)致的瘢痕組織和纖維化組織使腹腔鏡手術(shù)轉(zhuǎn)為開腹切除術(shù)較多、多療程抗生素治療憩室炎復(fù)發(fā)導(dǎo)致抗生素耐藥細菌流行率較高。但這些管理數(shù)據(jù)存在局限性：可能低估了創(chuàng)口感染。

　　與結(jié)直腸癌手術(shù)相比，結(jié)腸切除術(shù)治療炎性疾病后的校正轉(zhuǎn)歸都是最差的，院內(nèi)死亡的OR為6.54，進行造口術(shù)的OR為71.42，并且所有術(shù)后并發(fā)癥的風(fēng)險均較高。

　　校正共病評分和其他因素后，憩室病的總住院費用比結(jié)直腸癌患者高6678.78美元，IBD患者比結(jié)直腸癌患者高18557.13美元（P值均<0.001）。憩室病的校正住院時間長1天，IBD的校正住院時間長3天（P值均<0.001）。

　　當(dāng)非手術(shù)成功治療急性憩室炎后考慮常規(guī)擇期結(jié)腸切除術(shù)時，應(yīng)意識到這些相對較差的轉(zhuǎn)歸。該團隊指出，風(fēng)險比例失調(diào)在預(yù)期之外，但是這有可能是因為憩室炎是炎性疾病，而結(jié)腸癌不是。

　　Outcomes and Costs of Elective Surgery for Diverticular Disease: A Comparison With Other Diseases Requiring Colectomy.

　　OBJECTIVE

　　To compare outcomes and costs of elective surgery for diverticular disease (DD) with those of other diseases commonly requiring colectomy. DESIGN Multivariable analyses using the Nationwide Inpatient Sample to compare outcomes across primary diagnosis while adjusting for age, sex, race, year of admission, and comorbid disease. SETTING A sample of US hospital admissions from 2003-2009. PATIENTS All adult patients (≥18 years) undergoing elective resection of the descending colon or subtotal colectomy who had a primary diagnosis of DD, colon cancer (CC), or inflammatory bowel disease (IBD). MAIN OUTCOME MEASURES In-hospital mortality, postoperative complications, ostomy placement, length of stay, and hospital charges. RESULTS Of the 74 879 patients, 50.52% had DD, 43.48% had CC, and 6.00% had IBD. After adjusting for other variables, patients with DD were significantly more likely than patients with CC to experience in-hospital mortality (adjusted odds ratio, 1.90; 95% CI, 1.37-2.63; P &lt; .001), develop a postoperative infection (1.67; 1.48-1.89; P &lt; .001), and have an ostomy placed (1.87; 1.65-2.11; P &lt; .001). The adjusted total hospital charges for patients with DD were $6678.78 higher (95% CI, $5722.12-$7635.43; P &lt; .001) and length of stay was 1 day longer (95% CI, 0.86-1.14; P &lt; .001) compared with patients with CC. Patients with IBD had the highest in-hospital mortality, highest rates of complications and ostomy placement, longest length of stay, and highest hospital charges. CONCLUSIONS Despite undergoing the same procedure, patients with DD have significantly worse and more costly outcomes after elective colectomy compared with patients with CC but better than patients with IBD. These relatively poor outcomes should be recognized when considering routine elective colectomy after successful nonoperative management of acute diverticulitis.