Ben Ameur Hazem, Boujelbene Salah, Beyrouti Mohamed Issam
Tunis Med. 2013 Oct;91(10):565-72.
Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review.
Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications.
An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012.
Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose (evidence level 2, grade recommendation B). Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt , a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% (level evidence 4, recommendation grade C). PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression (evidence level 2, recommendation grade B). The cecostomy is more effective and safer than conventional colostomy (level of evidence 4, recommendation grade C). The cecostomy is highly effective in colonic decompression but associated with a high mortality (level of evidence 4, recommendation grade C).
Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression.
奥吉尔维综合征是指既往健康的结肠出现无器质性梗阻的急性结肠扩张。手术是治疗并发坏死或穿孔病例的唯一方法。相比之下，非复杂性病例的治疗方法并不统一，本文献综述将对此进行探讨。
根据消除结肠扩张的效率、复发率、发病率和死亡率，确定非复杂性奥吉尔维综合征不同治疗方法的效果。明确其各自的适应证。
在“MEDLINE”数据库中进行电子文献检索，并辅以人工查阅文章的参考文献列表，检索时间为1980年至2012年。
保守治疗在53%至96%的病例中有效，结肠穿孔风险小于2.5%，死亡率为0至14%（证据级别4，推荐等级C）。新斯的明首次给药后在64%至91%的病例中有效，复发风险为0至38%。第二次给药后在40%至100%的病例中仍有效（证据级别2，推荐等级B）。内镜减压是一种安全有效的技术，首次尝试成功率为61%至100%，复发率为0至50%，结肠穿孔率小于5%，死亡率小于5%（证据级别4，推荐等级C）。在新斯的明或内镜减压成功治疗后，可推荐使用聚乙二醇预防急性结肠假性梗阻复发（证据级别2，推荐等级B）。盲肠造口术比传统结肠造口术更有效、更安全（证据级别4，推荐等级C）。盲肠造口术在结肠减压方面非常有效，但死亡率较高（证据级别4，推荐等级C）。
首选保守治疗。若治疗失败，应尝试使用新斯的明。若仍未成功，则建议进行内镜减压。盲肠造口术是内镜减压失败后的最后手段。
