Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
Department of Hepatology, Shimane Prefectural Central Hospital, Izumo, Japan.
Dig Dis Sci. 2021 Apr;66(4):1162-1167. doi: 10.1007/s10620-020-06317-z. Epub 2020 May 14.
Sigmoid volvulus is a common condition in elderly patients with elongated colons. Although endoscopic de-torsion is effective as the primary treatment of sigmoid volvulus, elective surgery is recommended because of the high risk of recurrence and high mortality rate.
The aim of this study was to determine the risk factors for the recurrence of sigmoid volvulus.
Clinical records of patients treated at Shimane Prefectural Central Hospital were reviewed retrospectively. Among 41 sigmoid volvulus patients who were successfully treated by endoscopic de-torsion and followed up, 30 were observed over 1 year. Among the 30 patients, eight (26.7%) did not experience recurrence, while 22 (73.3%) did. Initial computed tomography (CT) findings indicating the sigmoid colon extending to the diaphragm or ventral to the liver were defined as "extension findings." Extension findings and sigmoid diameter were evaluated in relation to sigmoid volvulus recurrence.
Extension findings were significantly more frequent in the recurrent group (77.3%) than in the nonrecurrent group (25.0%) (P = 0.009). Distended sigmoid colon diameter was significantly larger in the recurrent group (11.7 ± 3.8 cm) than in the nonrecurrent group (7.1 ± 1.1 cm) (P = 0.044). Receiver operating characteristic curve analysis demonstrated that the performance threshold was greater than 8.9 cm. Kaplan-Meier analysis showed the significantly high sigmoid volvulus recurrence rate in the patients with extension findings and a distended sigmoid colon greater than 8.9 cm.
CT findings of a long and distended sigmoid colon in initial sigmoid volvulus are risk factors for the recurrence of sigmoid volvulus.
乙状结肠扭转是老年人中一种常见的结肠冗长性疾病。尽管内镜复位是乙状结肠扭转的主要治疗方法，但由于复发风险高和死亡率高，建议选择性手术。
本研究旨在确定乙状结肠扭转复发的危险因素。
回顾性分析岛根县立中央医院治疗的患者的临床记录。在成功接受内镜复位治疗并随访的 41 例乙状结肠扭转患者中，有 30 例观察时间超过 1 年。在这 30 例患者中，8 例（26.7%）未复发，22 例（73.3%）复发。初始计算机断层扫描（CT）发现乙状结肠延伸至膈肌或肝腹侧被定义为“延伸发现”。评估延伸发现和乙状结肠直径与乙状结肠扭转复发的关系。
复发组的延伸发现明显多于非复发组（77.3% vs. 25.0%）（P=0.009）。复发组的扩张乙状结肠直径明显大于非复发组（11.7±3.8cm vs. 7.1±1.1cm）（P=0.044）。受试者工作特征曲线分析表明，性能阈值大于 8.9cm。Kaplan-Meier 分析显示，存在延伸发现和扩张乙状结肠大于 8.9cm 的患者乙状结肠扭转复发率显著较高。
初始乙状结肠扭转时 CT 显示乙状结肠长而扩张是乙状结肠扭转复发的危险因素。
