Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Colorectal Dis. 2018 Jun;20(6):529-535. doi: 10.1111/codi.13972.
Sigmoid volvulus is a condition with a tendency to recur if treated conservatively. Little is known about the best type of treatment or when to perform definitive surgery. The aim of this study was to review treatment, and assess the outcome, of sigmoid volvulus in adult patients treated at a Swedish university hospital.
The medical records of patients treated for sigmoid volvulus at Sahlgrenska University Hospital, Sweden from January 2000 to September 2016 were reviewed retrospectively. Median follow-up time was 8.3 years.
One hundred and sixty-eight patients were included with a total of 453 admissions for sigmoid volvulus. Nonoperative decompression was attempted as the initial treatment in 438/453 (97%), with a success rate of 92% (403/438), which was not influenced by whether it was the first episode or a recurrence. Without planned surgery, recurrence occurred after 84% of successful nonoperative decompressions with a median of two recurrences (1-16). Recurrence was less common after the first episode compared with subsequent episodes. Median time until recurrence was 58 days. Mortality after planned surgery following successful decompression was 3.3% (2/61) compared with 13% (6/46) following emergency surgery.
In our cohort, the recurrence rate of sigmoid volvulus following successful nonoperative decompression was high. Still, more than 20% of patients did not experience a recurrence after their first episode. Nonoperative decompression could thus be suggested as the sole treatment for the first episode of volvulus. However, after the second episode it is probable that early planned surgery would improve outcome and reduce health-care consumption.
乙状结肠扭转如果采用保守治疗，有复发的倾向。对于最佳治疗方法或何时进行确定性手术，知之甚少。本研究旨在回顾瑞典一家大学医院治疗的成人乙状结肠扭转患者的治疗方法，并评估其结果。
回顾性分析 2000 年 1 月至 2016 年 9 月期间在瑞典萨尔格伦斯卡大学医院治疗乙状结肠扭转的患者的病历。中位随访时间为 8.3 年。
共纳入 168 例患者，总计 453 例乙状结肠扭转住院患者。453 例患者中，438 例（97%）尝试了非手术减压作为初始治疗，成功率为 92%（403/438），是否为首次发作或复发并不影响成功率。在没有计划手术的情况下，成功的非手术减压后 84%（403/438）的患者出现复发，中位复发时间为 2 次（1-16 次）。首次发作后复发的情况较后续发作少见。中位复发时间为 58 天。在成功减压后进行计划性手术的患者中，死亡率为 3.3%（2/61），而在紧急手术后死亡率为 13%（6/46）。
在我们的队列中，成功非手术减压后乙状结肠扭转的复发率较高。尽管如此，超过 20%的患者在首次发作后没有复发。因此，非手术减压可作为首次发作的单一治疗方法。然而，在第二次发作后，早期计划手术可能会改善预后并减少医疗保健的消耗。
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