Maddah Ghodratollah, Kazemzadeh Gholam Hossein, Abdollahi Abbas, Bahar Mostafa Mehrabi, Tavassoli Alireza, Shabahang Hossein
Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
J Coll Physicians Surg Pak. 2014 Jan;24(1):13-7.
To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus.
A case series.
Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008.
A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software (version 18) was used for the data analysis.
In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 (36.87%) cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 (63.13%) patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 (29.1%), Mikulicz procedure in 9 (6.6%), laparotomy detorsion in 37 (27.01%), Hartmann procedure in 47 (34.3%), mesosigmoidoplasty in 3 (2.19%) patients and total colectomy in one (0.73%) case. The overall mortality was 9.8% (22) patients.
In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement.
参照所施行的外科手术类型描述乙状结肠扭转的处理方式，并确定乙状结肠扭转的预后。
病例系列研究。
1996年至2008年，伊朗马什哈德医科大学加姆医院。
共回顾了944例结肠梗阻病例。记录人口统计学、实验室检查及治疗结果、死亡率和并发症情况。使用描述性统计分析数据，定性变量采用频率和百分比，定量变量采用均值和标准差。同时，使用卡方检验和费舍尔精确检验分析定性变量之间的关联性。采用SPSS统计软件（版本18）进行数据分析。
除有坏疽性肠管症状或体征的患者外，所有患者均经直肠乙状结肠镜插入一根长直肠管，80例（36.87%）成功。137例（63.13%）患者直肠乙状结肠镜复位失败，接受了急诊剖腹手术。这些病例所施行的外科手术包括：40例（29.1%）切除并一期吻合术、9例（6.6%）米库利兹手术、37例（27.01%）剖腹复位术、47例（34.3%）哈特曼手术、3例（2.19%）患者行乙状结肠系膜成形术以及1例（0.73%）全结肠切除术。总死亡率为9.8%（22例）患者。
在乙状结肠扭转中，患者预后的最重要决定因素是肠管活力。乙状结肠扭转的初始治疗是乙状结肠镜检查并放置直肠管。
