Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France.
Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France.
Dig Liver Dis. 2019 Mar;51(3):386-390. doi: 10.1016/j.dld.2018.10.003. Epub 2018 Oct 11.
Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery.
The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus.
The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'.
Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery.
Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed.
乙状结肠扭转是老年和虚弱患者结肠梗阻的常见原因。其标准治疗包括结肠镜下结肠环松解，随后择期行乙状结肠切除术以预防复发。然而，这些患者往往不适合手术。
本研究旨在比较乙状结肠扭转内镜松解后择期行乙状结肠切除术与保守治疗的死亡率。
回顾性分析 2008 年至 2014 年期间 83 例行乙状结肠扭转内镜松解术患者的病历。患者分为两组：“择期手术”组和“非手术”组。
“非手术”组（n=42）患者年龄较大，自理能力较“择期手术”组差。96%的患者成功进行了乙状结肠扭转内镜松解术，无并发症。中位随访时间为 13 个月（1 天至 67 个月）。“非手术”组死亡率为 62%，“择期手术”组死亡率为 32%（p=0.02）。“非手术”组中有 23/42 例患者出现乙状结肠扭转复发，手术后无复发。
首次发生乙状结肠扭转后必须尽快计划择期手术。对于虚弱的患者，必须开发其他选择。
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