肠旋转不良的临床诊断与治疗分析。
Analysis of clinical diagnosis and treatment of intestinal volvulus.
机构信息
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
出版信息
BMC Gastroenterol. 2023 Mar 28;23(1):93. doi: 10.1186/s12876-023-02699-2.
BACKGROUND
The aim of this study is to investigate the clinical characteristics and treatment experience of intestinal volvulus, and to analyze the incidence of adverse events and related risk factors of intestinal volvulus.
METHODS
Thirty patients with intestinal volvulus admitted to the Digestive Emergency Department of Xijing Hospital from January 2015 to December 2020 were selected. The clinical manifestations, laboratory tests, treatment and prognosis were retrospectively analyzed.
RESULTS
A total of 30 patients with volvulus were enrolled in this study, including 23 males (76.7%), with a median age of 52 years (33-66 years). The main clinical manifestations were abdominal pain in 30 cases (100%), nausea and vomiting in 20 cases (67.7%), cessation of exhaust and defecation in 24 cases (80%), and fever in 11 cases (36.7%). The positions of intestinal volvulus were jejunum in 11 cases (36.7%), ileum and ileocecal in 10 cases (33.3%), sigmoid colon in 9 cases (30%). All 30 patients received surgical treatment. Among the 30 patients underwent surgery, 11 patients developed intestinal necrosis. We found that the longer the disease duration (> 24 h), the higher the incidence of intestinal necrosis, and the higher the incidence of ascites, white blood cell count and neutrophil ratio in the intestinal necrosis group were significantly higher than those in the non-intestinal necrosis group (p < 0.05). After treatment, 1 patient died of septic shock after operation, and 2 patients with recurrent volvulus were followed up within 1 year. The overall cure rate was 90%, the mortality rate was 3.3%, and the recurrence rate was 6.6%.
CONCLUSION
Laboratory examination, abdominal CT and dual-source CT are very important for the diagnosis of volvulus in patients with abdominal pain as the main symptom. Increased white blood cell count, neutrophil ratio, ascites and long course of disease are important for predicting intestinal volvulus accompanied by intestinal necrosis. Early diagnosis and timely intervention can save lives and prevent serious complications.
背景
本研究旨在探讨肠扭转的临床特征和治疗经验，并分析肠扭转不良事件的发生率及相关危险因素。
方法
选取 2015 年 1 月至 2020 年 12 月西京医院消化急诊收治的 30 例肠扭转患者，回顾性分析其临床表现、实验室检查、治疗及预后。
结果
本研究共纳入 30 例肠扭转患者，其中男 23 例（76.7%），中位年龄 52 岁（33~66 岁）。主要临床表现为腹痛 30 例（100%），恶心呕吐 20 例（67.7%），排气排便停止 24 例（80%），发热 11 例（36.7%）。肠扭转部位：空肠 11 例（36.7%），回肠及回盲部 10 例（33.3%），乙状结肠 9 例（30%）。30 例患者均接受手术治疗。手术中发现 11 例肠坏死。我们发现，病程越长（>24 h），肠坏死发生率越高，肠坏死组的腹水、白细胞计数和中性粒细胞比例明显高于非肠坏死组（p<0.05）。治疗后，1 例患者术后发生感染性休克死亡，2 例复发肠扭转患者在 1 年内随访。总治愈率为 90%，死亡率为 3.3%，复发率为 6.6%。
结论
对于以腹痛为主要症状的患者，实验室检查、腹部 CT 和双源 CT 对诊断扭转非常重要。白细胞计数、中性粒细胞比例、腹水增加和病程延长对预测伴有肠坏死的肠扭转具有重要意义。早期诊断和及时干预可以挽救生命，预防严重并发症。
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