Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Tokyo, Japan.
Dig Endosc. 2014 Jul;26(4):564-8. doi: 10.1111/den.12235. Epub 2014 Feb 17.
Although intestinal obstruction as a result of sigmoid volvulus (SV) may be successfully resolved using endoscopic detorsion, surgical treatment remains the main therapeutic strategy. We evaluated the endoscopic detorsion procedure using unsedated water-immersion colonoscopy for the treatment of SV.
A retrospective chart review was conducted on the clinical background and prognosis of 21 SV patients who underwent 71 endoscopic detorsion procedures using unsedated, water-immersion colonoscopy.
In all, 14 (67%) male and seven (33%) female patients, with a mean age of 73 years (range, 54-95 years) were enrolled; 86% were >70 years of age. Among these patients, 90% had a background of key predisposing factors. In the 21 patients, endoscopic detorsion was successfully done using unsedated water-immersion colonoscopy. SV recurred in 10 patients at a median of 180 days. Endoscopic detorsion for recurrent SV was successfully achieved in all cases, and none of the secondary cases became severe. Only male patients were observed to experience three or more recurrent episodes of SV.
SV occurred most commonly in elderly patients with a surgical risk. Our experience suggests that conservative endoscopic treatment using unsedated water-immersion colonoscopy is a safe, reasonable, conservative endoscopic approach for elderly patients in the absence of necrotic findings. We currently use this procedure in most of our cases.
尽管乙状结肠扭转（SV）引起的肠梗阻可以通过内镜松解成功解决，但手术治疗仍然是主要的治疗策略。我们评估了使用非镇静性水浸式结肠镜检查治疗 SV 的内镜松解程序。
对 21 例接受非镇静性水浸式结肠镜检查进行 71 次内镜松解术的 SV 患者的临床背景和预后进行回顾性图表回顾。
共有 14 名（67%）男性和 7 名（33%）女性患者，平均年龄为 73 岁（范围为 54-95 岁）；86%的患者年龄超过 70 岁。在这些患者中，90%有主要易患因素的背景。在 21 例患者中，使用非镇静性水浸式结肠镜检查成功进行了内镜松解。10 例患者在中位数为 180 天的时间内出现 SV 复发。所有病例均成功地进行了复发性 SV 的内镜松解，并且没有一个病例变得严重。只有男性患者观察到 3 次或更多次 SV 复发。
SV 最常发生在有手术风险的老年患者中。我们的经验表明，在没有坏死发现的情况下，使用非镇静性水浸式结肠镜检查的保守内镜治疗是一种安全、合理的老年患者保守内镜方法。我们目前在大多数病例中使用此程序。
