Naef M, Maurer C A, Scheurer U, Seidel K, Langen H P, Sell F, Büchler M W
Klinik für Viszeral- und Transplantationschirurgie, Universität Bern, Inselspital.
Zentralbl Chir. 1998;123(12):1360-4.
Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by abdominal distention and massive colonic dilatation without any mechanical cause of obstruction. We have reviewed the records of 57 patients, 36 men and 21 women (median age 65.4 y), from 1/1992 to 12/1996, with a colonic pseudo-obstruction, defined as dilatation of at least 10 cm on plain abdominal x-ray. 38 cases (66.5%) followed surgery or trauma and 19 (33.5%) developed symptoms during severe medical illness. 36 cases (63.2%) got i.v. narcotics prior to development of Ogilvie's syndrome. 4 patients underwent conservative treatment alone, 53 patients (93%) had endoscopic decompression with a decompression tube placed in 49 (86%). Due to 2 failures and 2 complications of endoscopic treatment (one ischemic lesion, one perforation; complication rate 3.8%) 4/53 patients had to be operated (7.5%). Clinical success of endoscopic treatment was 88.6% at first attempt and 92.5% at second attempt. General complications tended to be severe, according to the concomitant diseases (morbidity 35%); overall hospital mortality was 21% (12/57). In conclusion, we believe that endoscopic decompression and tube placement is effective and safe for acute colonic pseudo-obstruction not responding to 24 hour conservative treatment.
急性结肠假性梗阻（奥吉尔维综合征）的特征是腹部膨胀和大量结肠扩张，且无任何机械性梗阻原因。我们回顾了1992年1月至1996年12月期间57例患者的记录，其中男性36例，女性21例（中位年龄65.4岁），均患有结肠假性梗阻，定义为腹部平片显示至少10厘米的扩张。38例（66.5%）患者有手术或外伤史，19例（33.5%）在严重内科疾病期间出现症状。36例（63.2%）患者在奥吉尔维综合征发生前接受了静脉注射麻醉剂。4例患者仅接受保守治疗，53例（93%）患者接受了内镜减压，其中49例（86%）放置了减压管。由于内镜治疗出现2例失败和2例并发症（1例缺血性病变，1例穿孔；并发症发生率3.8%），53例患者中有4例（7.5%）不得不接受手术。内镜治疗的首次尝试临床成功率为88.6%，第二次尝试为92.5%。根据伴随疾病，一般并发症往往较为严重（发病率35%）；总体医院死亡率为21%（12/57）。总之，我们认为内镜减压和放置导管对于24小时保守治疗无效的急性结肠假性梗阻是有效且安全的。
