Turan M, Sen M, Karadayi K, Koyuncu A, Topcu O, Yildirir C, Duman M
University Faculty of Medicine, Department of General Surgery, Sivas, Turkey.
Rev Esp Enferm Dig. 2004 Jan;96(1):32-5. doi: 10.4321/s1130-01082004000100005.
BACKGROUND/AIMS: The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus.
We present our experience of 81 cases of sigmoid volvulus admitted to our department.
Preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann's pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus.
Initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.
背景/目的：乙状结肠是肠扭转最常见的部位。在本报告中，我们回顾了我们治疗乙状结肠扭转的经验。
我们介绍了收治于我科的81例乙状结肠扭转患者的治疗经验。
所有患者均尝试术前内镜下扭转复位，其中39例成功。使用柔性结肠镜进行乙状结肠扭转内镜复位的成功率（60%）高于使用硬式直肠乙状结肠镜（42%）。在这39例非手术复位的患者中，19例在复位后7 - 10天内进行了乙状结肠切除并一期吻合，但20例患者在非手术治疗后未接受择期手术。在61例因乙状结肠扭转接受急诊或择期手术的患者中，17例仅行剖腹扭转复位，19例行择期吻合切除，6例行一期吻合切除，19例行Hartmann袋式切除。42例接受急诊手术的患者中有9例死亡（21%），19例接受择期手术的患者中有1例（5.2%）因脑栓塞死亡。
内镜初始治疗可实现减压并使患者为手术切除做好充分准备，在扭转复位过程中，柔性结肠镜比硬质器械具有显著优势。
