Jetmore A B, Timmcke A E, Gathright J B, Hicks T C, Ray J E, Baker J W
Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, Louisiana 70121.
Dis Colon Rectum. 1992 Dec;35(12):1135-42. doi: 10.1007/BF02251964.
Forty-eight cases of Ogilvie's syndrome, colonic pseudo-obstruction, presenting between 1983 and 1989 were retrospectively reviewed to assess the results of colonoscopic decompression and to identify potential etiologic factors. Three patients had spontaneous resolution with medical treatment. Forty-five patients required 60 colonoscopic decompressions: 38 (84 percent) were successfully treated using colonoscopy; five (11 percent) required an operation; and two died within 48 hours of colonoscopy from medical causes. No complications or deaths were the result of colonoscopy. Twenty-nine patients (64 percent) were successfully treated with a single colonoscopy. One-third of patients required serial decompressions. Average cecal diameter in patients with successful colonoscopic decompression was 12.4 cm but was larger for patients requiring more than one colonoscopy (13.3 cm) and for those who failed colonoscopic therapy (13.4 cm). The spine or retroperitoneum had been traumatized or manipulated in 52 percent of patients. Patients with Ogilvie's syndrome were being treated with narcotics (56 percent), H-2 blockers (52 percent), phenothiazines (42 percent), calcium-channel blockers (27 percent), steroids (23 percent), tricyclic antidepressants (15 percent), and epidural analgesics (6 percent) at diagnosis. Electrolyte abnormalities included hypocalcemia (63 percent), hyponatremia (38 percent), hypokalemia (29 percent), hypomagnesemia (21 percent), and hypophosphatemia (19 percent). Colonoscopic decompression in Ogilvie's syndrome is safe and effective management. Multiple pharmacologic and metabolic factors, as well as spinal and retroperitoneal trauma, appear to alter autonomic regulation of colonic function, resulting in colonic pseudo-obstruction.
回顾性分析了1983年至1989年间出现的48例奥吉尔维综合征（结肠假性梗阻）病例，以评估结肠镜减压的效果并确定潜在病因。3例患者经药物治疗后自行缓解。45例患者需要进行60次结肠镜减压：38例（84%）通过结肠镜成功治疗；5例（11%）需要手术治疗；2例在结肠镜检查后48小时内因内科原因死亡。结肠镜检查未导致并发症或死亡。29例患者（64%）通过单次结肠镜检查成功治疗。三分之一的患者需要多次减压。结肠镜减压成功的患者平均盲肠直径为12.4 cm，但需要多次结肠镜检查的患者（13.3 cm）和结肠镜治疗失败的患者（13.4 cm）的盲肠直径更大。52%的患者曾有脊柱或腹膜后受到创伤或接受过手术操作。诊断时，奥吉尔维综合征患者正在使用麻醉药（56%）、H-2阻滞剂（52%）、吩噻嗪类药物（42%）、钙通道阻滞剂（27%）、类固醇（23%）、三环类抗抑郁药（15%）和硬膜外镇痛药（6%）进行治疗。电解质异常包括低钙血症（63%）、低钠血症（38%）、低钾血症（29%）、低镁血症（21%）和低磷血症（19%）。结肠镜减压是治疗奥吉尔维综合征安全有效的方法。多种药理和代谢因素，以及脊柱和腹膜后创伤，似乎会改变结肠功能的自主调节，导致结肠假性梗阻。
