乙状结肠扭转40例的诊断与治疗

目的 探讨乙状结肠扭转的病因、诊断及治疗方法。方法 对1990年1月-2002年5月诊治的40例乙状结肠扭转的临床资料进行回顾性分析。结果 术前明确诊断31例、误诊为粘连性肠梗阻3例、绞窄性小肠梗阻2例。消化道穿孔弥漫性腹膜炎2例、腹痛待查2例。行非手术治疗8例,其中4例复发;手术治疗32例,其中单纯复位术11例,2例复发;复位加固定术8例,1例复发;复位加系膜折叠术6例;Hartmann术3例;乙状结肠切除一期吻合术4例。治愈38例,死亡2例。结论 本病的诊断主要依靠临床表现及腹部X线检查。治疗以手术为主,可根据病情及扭转情况选择适当的术式。

Clinical analysis of sigmoid volvulus: report of 40 Cases

Objective The aim of the study was to explore etiology, diagnosis and treatment of sigmoid volvulus . Methods A retrospective study of 40 patients with sigmoid volvulus (SV) from January, 1990 to May, 2002 was conducted. Results Of the 40 cases, preoperative diagnosis in 31 patients were clear. 3 patients were misdiagnosed as adhesive ileus for 3 patients, 2 patients strangulated intertinal obstruction, diffuse peritonitis of perforation of digestive tract 2 patients, 2 patients abdominal pain. Of the 8 patients who did not undergo surgery, sigmoid volvulus recured in 4 patients. Of the 32 patients who had surgery, 11 patients had simple reduction with recurrence in 2 patients; 8 patients reduction combined with immobilization with recurence in 1 patients; 6 paients had reduction combined with mesentery folded operation; 3 paients Hartmann s operation; 4 paients sigmoid resection combined with primary anastomosis. 38 paients were cured and 2 patients died. Conclusions The diagnosis was mainly depended on clinical symptoms and X -ray examination of abdomen. Operation was the main therapeutic approach and reasonable procedures should be chosen.