Kasten Kevin R, Marcello Peter W, Roberts Patricia L, Read Thomas E, Schoetz David J, Hall Jason F, Francone Todd D, Ricciardi Rocco
Department of Colorectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
Dis Colon Rectum. 2015 May;58(5):502-7. doi: 10.1097/DCR.0000000000000340.
Operative results of volvulus are largely unknown because of infrequent diagnosis.
We examined the results of operative intervention for colonic volvulus.
We merged trackable data from the California Inpatient Database with Supplemental Files for Revisit Analyses between January 1, 2005, and December 31, 2007.
Trackable data from California discharge records.
We identified all of the patients with colonic volvulus who underwent 1 of 4 surgical procedures, including manipulation/fixation of the colon, right colectomy, left colectomy, or total colectomy.
During the 36-month study period, we identified recurrence risk, recurrence requiring reoperation, time to reoperation, stoma formation, disposition on discharge, and in-hospital mortality. Fisher exact, χ(2), and ANOVA tests were used when appropriate.
We identified 2141 patients with colonic volvulus who were undergoing intraoperative manipulation/fixation of the colon (n = 209 (12%)), right (n = 728 (41%)), left (n = 781 (44%)), or total colectomy (n = 56 (3%)). Patients treated with intraoperative manipulation/fixation were younger, more likely to be women, and more likely to have private insurance. Patients who underwent total colectomy had the highest risk of mortality (21%), highest risk of stoma creation (64%), and longest length of stay (18 days); were more likely to be readmitted (9%); and were the most likely to be discharged to a skilled nursing facility (48%). Patients treated with intraoperative manipulation/fixation had the lowest mortality, risk of stoma formation, length of stay, and likelihood of discharge to skilled nursing facility but the highest risk of subsequent procedures for volvulus (26%) over a follow-up ranging from 0 to 687 days.
This study was limited by retrospective study design, heterogeneous patient factors, and inability to identify the time of last follow-up.
The majority of patients with volvulus underwent a resectional procedure. A subset without resection had favorable initial outcomes but remained at high risk for subsequent procedures. There may be a potential role for evaluating intraoperative manipulation/fixation in a small subset of patients with colonic volvulus.
由于诊断不常见，肠扭转的手术结果在很大程度上尚不明确。
我们研究了结肠扭转手术干预的结果。
我们将2005年1月1日至2007年12月31日期间加利福尼亚住院患者数据库中的可追踪数据与用于复诊分析的补充文件进行了合并。
来自加利福尼亚出院记录的可追踪数据。
我们确定了所有接受4种手术之一的结肠扭转患者，这4种手术包括结肠的手法复位/固定、右半结肠切除术、左半结肠切除术或全结肠切除术。
在36个月的研究期间，我们确定了复发风险、需要再次手术的复发情况、再次手术时间、造口形成情况、出院处置情况以及住院死亡率。在适当的时候使用了Fisher精确检验、χ²检验和方差分析。
我们确定了2141例结肠扭转患者，他们正在接受结肠的术中手法复位/固定（n = 209（12%））、右半结肠切除术（n = 728（41%））、左半结肠切除术（n = 781（44%））或全结肠切除术（n = 56（3%））。接受术中手法复位/固定治疗 的患者更年轻，更有可能是女性，并且更有可能拥有私人保险。接受全结肠切除术的患者死亡率最高（21%），造口形成风险最高（64%），住院时间最长（18天）；再次入院的可能性更大（9%）；并且最有可能被转至专业护理机构（48%）。在0至687天的随访期间，接受术中手法复位/固定治疗的患者死亡率、造口形成风险、住院时间以及转至专业护理机构的可能性最低，但随后因肠扭转进行再次手术的风险最高（26%）。
本研究受回顾性研究设计、患者因素异质性以及无法确定最后随访时间的限制。
大多数肠扭转患者接受了切除手术。一部分未接受切除术的患者初始结局良好，但后续手术风险仍然很高。对于一小部分结肠扭转患者评估术中手法复位/固定可能具有潜在作用。
