Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Surg Today. 2011 Apr;41(4):514-9. doi: 10.1007/s00595-010-4317-x. Epub 2011 Mar 23.
The present study reviewed the clinical outcomes of 453 elderly patients with sigmoid volvulus (SV).
The clinical records were reviewed retrospectively.
The mean patient age was 71.1 years of age, and 371 patients (81.9%) were male. Of the patients, 30.7% had recurrent volvulus, 34.6% had associated disease, and 16.5% suffered from shock. The correct diagnosis rate based on the clinical features was 66.4%. Radiography revealed SV findings in 64.9% of the patients. Computed tomography (CT) or magnetic resonance imaging (MRI) were diagnostic in all cases. Nonoperative detorsion was performed in 323 patients (71.3%) with 77.4% success, 1.2% mortality, 4.0% morbidity, and 4.4% early recurrence rates. Emergency surgery was required in 215 patients (47.5%) and resulted in 24.2% mortality, 41.4% morbidity, 0.9% early recurrence, and 8.1% late recurrence rates.
Elderly SV patients generally present with high percentages of recurrent volvulus, serious comorbidity, late admission, and shock. The clinical features may be less diagnostic. Radiological studies, particularly CT or MRI, may assist in an SV diagnosis. Nonoperative detorsion is advocated as the primary treatment. In emergency surgery, nonresectional or nonanastomotic procedures are preferred. The overall patient prognosis is grave, and the disease tends to recur.
本研究回顾了 453 例老年乙状结肠扭转（SV）患者的临床转归。
回顾性分析临床资料。
患者平均年龄为 71.1 岁，其中 371 例（81.9%）为男性。30.7%的患者有复发扭转，34.6%有合并症，16.5%有休克。根据临床特征的正确诊断率为 66.4%。64.9%的患者放射学检查显示有 SV 表现。所有病例均行 CT 或 MRI 检查明确诊断。323 例（71.3%）患者行非手术复位，成功率为 77.4%，死亡率为 1.2%，发病率为 4.0%，早期复发率为 4.4%。215 例（47.5%）患者需要紧急手术，死亡率为 24.2%，发病率为 41.4%，早期复发率为 0.9%，晚期复发率为 8.1%。
老年 SV 患者常伴有较高的复发扭转率、严重的合并症、较晚就诊和休克。临床特征可能不具诊断性。影像学检查，特别是 CT 或 MRI，有助于诊断 SV。非手术复位是首选的治疗方法。在紧急手术中，首选非切除或非吻合手术。整体患者预后较差，疾病易复发。
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