Sundin J A, Wasson D, McMillen M M, Ballantyne G H
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510.
Surg Laparosc Endosc. 1992 Dec;2(4):353-8.
A 75-year-old black man came to the emergency room because of nausea, vomiting, abdominal pain, and distension and obstipation. An abdominal radiograph revealed a sigmoid volvulus. This was nonoperatively reduced in the emergency room. Following a mechanical and antibiotic bowel preparation, the patient underwent elective exploration. We report, for the first time, operative treatment of sigmoid volvulus with a laparoscopic-assisted sigmoid colectomy and primary anastomosis. Because of dense fibrous scarring of the sigmoid mesentery produced by chronic mesosigmoiditis, the redundant sigmoid was exteriorized and resected extracorporeally. A stapled, side-to-side, functional end-to-end anastomosis was constructed. The patient experienced little postoperative pain and virtually no postoperative ileus. We believe that laparoscopic-assisted sigmoid resection may offer distinct advantages for the treatment of the typically elderly, debilitated patient in whom sigmoid volvulus develops. Furthermore, because of the characteristic mesosigmoiditis associated with sigmoid volvulus, we suspect that exteriorization and extracorporeal resection may prove the easiest and most rapid laparoscopic approach to this disease.
一名75岁黑人男性因恶心、呕吐、腹痛、腹胀及便秘前来急诊室。腹部X线片显示乙状结肠扭转。在急诊室进行了非手术复位。经过机械性和抗生素肠道准备后，患者接受了择期探查。我们首次报告了采用腹腔镜辅助乙状结肠切除术和一期吻合术治疗乙状结肠扭转。由于慢性乙状结肠系膜炎症导致乙状结肠系膜出现致密纤维瘢痕，将冗长的乙状结肠外置并在体外切除。进行了吻合器侧侧功能性端端吻合。患者术后疼痛轻微，几乎没有术后肠梗阻。我们认为，腹腔镜辅助乙状结肠切除术对于治疗发生乙状结肠扭转的典型老年体弱患者可能具有明显优势。此外，由于与乙状结肠扭转相关的特征性乙状结肠系膜炎症，我们怀疑外置和体外切除可能是针对该疾病最简单、最快捷的腹腔镜手术方法。
