King D W, Lubowski D Z, Armstrong A S
Colorectal Unit, St. George Hospital, Sydney, Australia.
Int J Colorectal Dis. 1990 Aug;5(3):161-3. doi: 10.1007/BF00300408.
Strictures of the sigmoid colon continue to pose a diagnostic dilemma. They commonly appear to be due to diverticular disease but carcinoma must always be excluded. In some cases diverticula may be present but in others there is no obvious cause for the stricture. In a series of 1039 consecutive colonoscopies performed between 1984 and 1986, 19 cases of sigmoid stricture that could not be negotiated with the colonoscope were encountered. In each case the cause of the stricture could not be demonstrated. Fifteen patients (79%) underwent laparotomy primarily on clinical grounds or with barium enema findings suggestive of carcinoma. A final diagnosis of diverticular disease was made in nine cases and adenocarcinoma is six cases. Barium enema was a poor predictor of malignancy in a stricture. Four patients were treated conservatively and two of these patients continued to have significant symptoms due to diverticular disease. This experience suggests that sigmoid strictures that prevent the passage of a colonoscope should be resected when the cause of the stricture is not apparent.
乙状结肠狭窄仍然是一个诊断难题。它们通常看似是由憩室病引起，但必须始终排除癌症。在某些情况下可能存在憩室，但在其他情况下，狭窄并无明显病因。在1984年至1986年连续进行的1039例结肠镜检查中，遇到了19例无法用结肠镜通过的乙状结肠狭窄病例。在每例中，狭窄的病因均无法证实。15例患者（79%）主要基于临床原因或钡剂灌肠检查结果提示癌症而接受了剖腹手术。最终诊断为憩室病的有9例，腺癌6例。钡剂灌肠对狭窄处恶性肿瘤的预测能力较差。4例患者接受了保守治疗，其中2例患者因憩室病仍有明显症状。这一经验表明，当狭窄病因不明时，应切除阻碍结肠镜通过的乙状结肠狭窄。
