Department of Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA.
J Gastrointest Surg. 2018 Aug;22(8):1404-1411. doi: 10.1007/s11605-018-3747-4. Epub 2018 Mar 22.
Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus.
The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy.
Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55-80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups.
Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.
乙状结肠扭转是一种不常见的肠梗阻病因，历史上与高发病率和死亡率相关。本研究的目的是评估乙状结肠扭转的当代治疗方法以及乙状结肠扭转患者行一期吻合术的安全性。
从 2012 年至 2015 年，查询国家手术质量改进计划中接受左侧结肠切除术的结肠扭转患者。进行倾向评分匹配分析，比较行结肠切除术和一期吻合术而无近端转流的乙状结肠扭转患者与行结肠切除术和末端回肠造口术的患者。
纳入 2538 例乙状结肠扭转患者进行分析。患者的中位年龄为 68 岁（四分位距，55-80），术前 79%完全独立。51%的手术为急诊手术。1813 例（71%）患者行结肠切除术和吻合术，240 例（10%）行结肠切除术和吻合术及近端转流，485 例（19%）行结肠切除术和末端回肠造口术。总体而言，30 天死亡率和发病率分别为 5%和 40%。经倾向评分匹配后，各组间死亡率、总发病率和严重发病率相似。
乙状结肠扭转发生在高龄和衰弱的患者中，具有较高的发病率、死亡率和对生活方式的影响。在选择合适的患者中，行一期吻合术而无需近端转流术治疗乙状结肠扭转的结果与行末端回肠造口术的结肠切除术相似。
