在急救环境中对急性乙状结肠扭转的适当处理。
Appropriate treatment of acute sigmoid volvulus in the emergency setting.
机构信息
Department of Colorectal Surgery, Changhai Hospital, Shanghai 200433, China.
出版信息
World J Gastroenterol. 2013 Aug 14;19(30):4979-83. doi: 10.3748/wjg.v19.i30.4979.
AIM
To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.
METHODS
A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.
RESULTS
Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus.
CONCLUSION
Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis.
目的
探讨一种适合治疗急诊急性乙状结肠扭转患者的策略。
方法
回顾性分析 2001 年 1 月至 2012 年 7 月上海长海医院肛肠外科收治的 28 例急性乙状结肠扭转患者的临床资料。在诊断为急性乙状结肠扭转后，如果没有弥漫性腹膜炎的证据，首先采用结肠镜治疗。
结果
28 例急性乙状结肠扭转患者中，男 19 例（67.9%），女 9 例（32.1%）；年龄 21~93 岁，平均 63.1±22.9 岁。6 例（21.4%）患者有腹部手术史，17 例（60.7%）患者有便秘史。所有患者均行腹部 X 线或 CT 检查。28 例患者均行结肠镜复位术，成功率为 92.8%（26/28）。另外 2 例患者需行急诊手术。26 例成功治疗的患者中，7 例（26.9%）复发。
结论
对于无并发症的急性乙状结肠扭转，结肠镜是首选的急诊治疗方法。只有在非手术治疗不成功或并发腹膜炎的情况下，才需要进行急诊手术。
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