Agirman Enes, Disci Esra, Peksoz Rifat, Atamanalp Sabri Selcuk
Enes Agirman, MD. Assistant Professor, Department of General Surgery, Erzurum City Hospital, Erzurum, Turkiye.
Esra Disc, MD. Associate Professor, Faculty of Medicine, Department of General Surgery, Ataturk University, Erzurum, Turkiye.
Pak J Med Sci. 2024 Dec;40(11):2513-2517. doi: 10.12669/pjms.40.11.10543.
Primary anastomosis and stoma are the main options in the restoration of intestinal continuity following urgent sigmoidectomy in sigmoid volvulus (SV). Our purpose was to evaluate the outcomes of both techniques in a 1,083-patient SV series.
Total 1,083 cases with SV treated in Ataturk University Research Hospital in 58-year period between June 1966 and July 2024 were included in this study. We reviewed the records of 612 patients (56.5%) retrospectively, while the remaining 471 cases (43.5%) were evaluated prospectively. We investigated some preoperative, operative, and postoperative characteristics in non-matched analyses.
Among total 379 patients treated with urgent colectomy, primary anastomosis was used in 173 cases (45.6%), while stoma was required in 206 patients (54.4%). The mean age was significantly lower in primary anastomosis group (P<0.005), while male/female ratios were statistically similar (P>0.05). Mean ASA score (P<0.001) and rates of shock (P<0.001), bowel gangrene (P<0.001), bowel perforation (P<0.01), and risky bowel (P<0.005) were also significantly lower in the primary anastomosis group. When stoma closure was considered, operation time was significantly shorter (P<0.001), additionally, morbidity and mortality rates were significantly lower in the primary anastomosis group (P<0.001, in each). The distributions of reoperation rates were statistically similar in both groups (P>0.05). Conversely, hospitalization time was significantly shorter and cost was significantly lower in the primary anastomosis group (P<0.001, in each).
Primary anastomosis has some advantages in comparison to stoma in the restoration of intestinal continuity following urgent sigmoidectomy in SV. However, stoma is generally preferred in patients with bad health status, old age, and risky bowel. New prospective randomized clinical studies or matched analyses may help to clarify the optimal choice.
在乙状结肠扭转（SV）患者行急诊乙状结肠切除术后，一期吻合和造口是恢复肠道连续性的主要选择。我们的目的是评估在一个包含1083例患者的SV系列中这两种技术的治疗效果。
本研究纳入了1966年6月至2024年7月期间在阿塔图尔克大学研究医院接受治疗的1083例SV患者。我们回顾性分析了612例患者（56.5%）的记录，其余471例患者（43.5%）进行前瞻性评估。我们在非配对分析中研究了一些术前、术中及术后特征。
在总共379例行急诊结肠切除术的患者中，173例（45.6%）采用一期吻合，206例（54.4%）需要造口。一期吻合组患者的平均年龄显著更低（P<0.005），而男女比例在统计学上相似（P>0.05）。一期吻合组的平均ASA评分（P<0.001）、休克发生率（P<0.001）、肠坏死发生率（P<0.001）、肠穿孔发生率（P<0.01）及高危肠发生率（P<0.005）也显著更低。考虑造口关闭时，一期吻合组的手术时间显著更短（P<0.001），此外，一期吻合组的发病率和死亡率也显著更低（均为P<0.001）。两组再次手术率的分布在统计学上相似（P>0.05）。相反，一期吻合组的住院时间显著更短，费用显著更低（均为P<0.001）。
在SV患者行急诊乙状结肠切除术后恢复肠道连续性方面，一期吻合与造口相比具有一些优势。然而，对于健康状况差、年龄较大及存在高危肠的患者，通常更倾向于选择造口。新的前瞻性随机临床研究或配对分析可能有助于明确最佳选择。
