Oren Durkaya, Atamanalp S Selçuk, Aydinli Bülent, Yildirgan M Ilhan, Başoğlu Mahmut, Polat K Yalçin, Onbaş Omer
Department of General Surgery, Atatürk University, School of Medicine, Erzurum, Turkey.
Dis Colon Rectum. 2007 Apr;50(4):489-97. doi: 10.1007/s10350-006-0821-x.
This study was designed to review the outcomes of emergent treatment of sigmoid colon volvulus.
The records of 827 patients were reviewed retrospectively.
The mean age was 57.9 years (range, 10 weeks to 98 years), and 688 patients (83.2 percent) were male. Nonoperative reduction was applied in 575 patients (barium enema in 13, rigid sigmoidoscopy in 351, and flexible sigmoidoscopy in 211, with rectal tube placement in all patients). The results were as follows: success of 78.1 percent, mortality of 0.9 percent, complication of 3 percent, and early recurrence of 3.3 percent. Surgical treatment was performed on 393 patients (detorsion in 46, mesosigmoidopexy in 56, exteriorization in 4, resection with Hartmann's procedure in 146, resection with Mikulicz procedure in 14, resection with primary anastomosis in 51, tube cecostomy and colonic cleansing with resection in 75, and laparotomy in 1). The results were as follows: mortality of 15.8 percent, complication of 37.2 percent, early recurrence of 0.8 percent, and late recurrence of 6.7 percent.
Nonoperative reduction is the initial treatment of sigmoid colon volvulus, and flexible sigmoidoscopy with rectal tube placement can be used successfully. Patients in whom bowel gangrene or peritonitis is present or nonoperative treatment is unsuccessful need emergency surgery. In surgical treatment, resection and primary anastomosis is the first choice, and it can be performed with acceptable mortality and morbidity rates if the patient is stable and a tension-free anastomosis is possible. Nondefinitive procedures have high recurrence rates; thus, definitive surgical techniques must be preferred.
本研究旨在回顾乙状结肠扭转的急诊治疗结果。
回顾性分析827例患者的病历。
平均年龄为57.9岁（范围为10周至98岁），688例患者（83.2%）为男性。575例患者采用非手术复位（13例采用钡剂灌肠，351例采用硬式乙状结肠镜检查，211例采用软式乙状结肠镜检查，所有患者均放置肛管）。结果如下：成功率为78.1%，死亡率为0.9%，并发症发生率为3%，早期复发率为3.3%。393例患者接受了手术治疗（46例扭转复位，56例乙状结肠系膜固定术，4例外置术，146例Hartmann手术切除，14例Mikulicz手术切除，51例一期吻合术切除，75例管形盲肠造口术及结肠灌洗并切除，1例剖腹探查）。结果如下：死亡率为15.8%，并发症发生率为37.2%，早期复发率为0.8%，晚期复发率为6.7%。
非手术复位是乙状结肠扭转的初始治疗方法，软式乙状结肠镜检查并放置肛管可成功应用。存在肠坏疽或腹膜炎或非手术治疗失败的患者需要急诊手术。在手术治疗中，切除并一期吻合是首选，如果患者情况稳定且可进行无张力吻合，则可在可接受的死亡率和发病率下进行。非确定性手术复发率高；因此，必须优先选择确定性手术技术。
