Rasilainen Suvi, Aden Mohamud, Kivelä Antti J, Pakarinen Sakari, Rintala Jukka, Niemeläinen Susanna, Helavirta Ilona, Moilanen Salla, Mattila Anne, Pinta Tarja, Saukkonen Kapo, Vento Pälvi, Turkka Niko, Pengermä Pasi, Häggblom Jenny, Scheinin Tom
Department of Gastrointestinal Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
Department of Gastrointestinal Surgery, Turku University Hospital, Turku, Finland.
BJS Open. 2025 Sep 8;9(5). doi: 10.1093/bjsopen/zraf113.
This study evaluated the outcomes of colonic volvulus management in a national cohort, and identified risk factors for morbidity and mortality.
This was a multicentre national retrospective study of patients presenting with colonic volvulus between 2010 and 2019. Main outcome measures were 30-day and 1-year mortality. Multivariable regression and Kaplan-Meier analyses were used to study predictors of mortality and survival.
Of the 559 patients presenting with sigmoid volvulus, 381 underwent surgery and 178 received conservative treatment. The 30-day mortality rates were 11.0% and 19.0%, respectively. Emergency surgery (P = 0.030), nursing home residence (P = 0.040), increased co-morbidity (P = 0.017), and male sex (P = 0.029) predicted postoperative 30-day mortality. Primary endoscopic detorsion followed by elective surgery during a subsequent hospital admission resulted in best survival. Of the 342 patients presenting with caecal volvulus, 340 underwent surgery. The 30-day mortality rate was 6.4%. Increased co-morbidity (P = 0.008), nursing home residence (P = 0.002), and necrotic caecum (P = 0.007) predicted 30-day mortality. At 1 year, the mortality rate among patients with sigmoid volvulus was 19.9% after surgery and 43.2% after conservative treatment. Emergency surgery (P = 0.023), nursing home residence (P = 0.009), and increased co-morbidity (P < 0.001) were associated with 1-year postoperative mortality. In patients with caecal volvulus the 1-year mortality rate was 13.1%. Increased co-morbidity (P < 0.001) and nursing home residence (P < 0.001) were predictive. Anastomotic leakage in patients with sigmoid volvulus was associated with an American Society of Anesthesiologists fitness grade of III (P = 0.032) and total colectomy (P = 0.012).
Surgery should be recommended for colonic volvulus where co-morbidity, patient preference, and functional status allows. Surgically unfit patients have poorer outcomes. Elective sigmoidectomy after endoscopic detorsion is preferred as it carries the lowest mortality risk. Necrotic bowel, dependency, and co-morbidities predict death for both sigmoid and caecal volvulus.
本研究评估了全国队列中结肠扭转的治疗结果，并确定了发病和死亡的危险因素。
这是一项对2010年至2019年间出现结肠扭转的患者进行的多中心全国性回顾性研究。主要结局指标为30天和1年死亡率。采用多变量回归和Kaplan-Meier分析来研究死亡率和生存率的预测因素。
在559例乙状结肠扭转患者中，381例接受了手术，178例接受了保守治疗。30天死亡率分别为11.0%和19.0%。急诊手术（P = 0.030）、养老院居住（P = 0.040）、合并症增加（P = 0.017）和男性（P = 0.029）是术后30天死亡率的预测因素。初次内镜复位后在随后的住院期间进行择期手术可获得最佳生存率。在342例盲肠扭转患者中，340例接受了手术。30天死亡率为6.4%。合并症增加（P = 0.008）、养老院居住（P = 0.002）和盲肠坏死（P = 0.007）是30天死亡率的预测因素。1年时，乙状结肠扭转患者术后死亡率为19.9%，保守治疗后为43.2%。急诊手术（P = 0.023）、养老院居住（P = 0.009）和合并症增加（P < 0.001）与术后1年死亡率相关。盲肠扭转患者1年死亡率为13.1%。合并症增加（P < 0.001）和养老院居住（P < 0.001）具有预测性。乙状结肠扭转患者的吻合口漏与美国麻醉医师协会身体状况分级为III级（P = 0.032）和全结肠切除术（P = 0.012）相关。
对于结肠扭转，在合并症、患者偏好和功能状态允许的情况下，应建议手术治疗。手术不适合的患者预后较差。内镜复位后择期乙状结肠切除术是首选，因为其死亡风险最低。肠坏死、依赖和合并症是乙状结肠和盲肠扭转患者死亡的预测因素。
