Lee Keunchul, Oh Heung-Kwon, Cho Jung Rae, Kim Minhyun, Kim Duck-Woo, Kang Sung-Bum, Kim Hyung-Jin, Park Hyoung-Chul, Shin Rumi, Heo Seung Chul, Ryoo Seung-Bum, Park Kyu Joo
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Ann Coloproctol. 2020 Dec;36(6):403-408. doi: 10.3393/ac.2020.03.23. Epub 2020 Dec 31.
This study aimed to evaluate real-world clinical outcomes from surgically treated patients for sigmoid volvulus.
Five tertiary centers participated in this retrospective study with data collected from October 2003 through September 2018, including demographic information, preoperative clinical data, and information on laparoscopic/open and elective/emergency procedures. Outcome measurements included operation time, postoperative hospitalization, and postoperative morbidity.
Among 74 patients, sigmoidectomy was the most common procedure (n = 46), followed by Hartmann's procedure (n = 23), and subtotal colectomy (n = 5). Emergency surgery was performed in 35 cases (47.3%). Of the 35 emergency patients, 34 cases (97.1%) underwent open surgery, and a stoma was established for 26 patients (74.3%). Elective surgery was performed in 39 cases (52.7%), including 21 open procedures (53.8%), and 18 laparoscopic surgeries (46.2%). Median laparoscopic operation time was 180 minutes, while median open surgery time was 130 minutes (P < 0.001). Median postoperative hospitalization was 11 days for laparoscopy and 12 days for open surgery. There were 20 postoperative complications (27.0%), and all were resolved with conservative management. Emergency surgery cases had a higher complication rate than elective surgery cases (40.0% vs. 15.4%, P = 0.034).
Relative to elective surgery, emergency surgery had a higher rate of postoperative complications, open surgery, and stoma formation. As such, elective laparoscopic surgery after successful sigmoidoscopic decompression may be the optimal clinical option.
本研究旨在评估乙状结肠扭转手术治疗患者的实际临床疗效。
五家三级医疗中心参与了这项回顾性研究，收集了2003年10月至2018年9月的数据，包括人口统计学信息、术前临床数据以及腹腔镜/开放手术和择期/急诊手术的信息。疗效指标包括手术时间、术后住院时间和术后发病率。
74例患者中，乙状结肠切除术是最常见的手术方式（n = 46），其次是哈特曼手术（n = 23）和次全结肠切除术（n = 5）。35例（47.3%）患者接受了急诊手术。在35例急诊患者中，34例（97.1%）接受了开放手术，26例（74.3%）患者进行了造口术。39例（52.7%）患者接受了择期手术，其中21例（53.8%）为开放手术，18例（46.2%）为腹腔镜手术。腹腔镜手术的中位时间为180分钟，而开放手术的中位时间为130分钟（P < 0.001）。腹腔镜手术后的中位住院时间为11天，开放手术为12天。术后有20例并发症（27.0%），均通过保守治疗得到解决。急诊手术病例的并发症发生率高于择期手术病例（40.0%对15.4%，P = 0.034）。
相对于择期手术，急诊手术的术后并发症发生率、开放手术率和造口形成率更高。因此，乙状结肠镜减压成功后择期腹腔镜手术可能是最佳的临床选择。
