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。     

乙状结肠扭转的诊断与治疗

乙状结肠扭转（ｓｉｇｍｏｉｄｖｏｌｖｉｕｓ，ＳＶ）是肠梗阻的常见原因之一，死亡率较高，可达１５％～２０％以上［１］。我们自１９８５年１月～１９９６年１２月共诊治４０例，现报告如下。１临床资料１．１一般资料本组男３４例，女６例，年龄２２～８５岁，平均年...     

乙状结肠扭转的诊断及治疗

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乙状结肠扭转24例诊治分析

乙状结肠扭转是肠梗组的常见原因，多见于老年患者，随着老龄人口在现代社会中所占比例的增大，其发病率有增高趋势。我院在１９８８年９月～１９９５年９月间共收治肠梗阻病人１５５例，其中乙状结肠扭转２４例。现报告如下。１临床资料１．１一般资料本组２４例，男１５...     

乙状结肠扭转的诊断及治疗--附27例临床分析

目的　总结乙状结肠扭转的诊治经验。方法　对２７ 例乙状结肠扭转患者的临床表现及治疗方法进行回顾性分析,结合文献讨论乙状结肠扭转的诊治问题。结果　１６ 例经腹部Ｘ 线检查确诊,其中６ 例经结肠镜诊断,４ 例经剖腹探查确诊,其中１ 例误诊为“胃扩张”。１６ 例行保守治疗,１２ 例成功,均无并发症表现。１５ 例手术治疗（８ 例扭转复位加固定术,７ 例乙状结肠一期切除吻合术） ,术后１ 例伴严重糖尿病者死于肺部感染及心律失常,无吻合口漏。结论　老年男性腹痛、腹胀和便秘应考虑本病的可能。Ｘ线检查可使约６０％ 的患者确诊。对于无肠坏死及腹膜炎的患者,行结肠镜检查有明显优点,诊断后即可试行复位,成功率高,风险小。对于有肠坏死及腹膜炎的患者,应及时手术治疗。     

乙状结肠扭转的诊断及治疗(附57例分析)

目的：总结乙状结肠扭转的诊治经验。方法：对57例乙状结肠扭转患者的临床表现及治疗方法进行回顾性分析。结果：32例行腹部X线平片检查,其中28例明确诊断,19例系钡灌肠检查显示“鸟嘴征”而作出诊断,7例通过结肠镜检查获得诊断,3例经剖腹探查证实本病;4例误诊或漏诊。非手术疗法9例,7例成功,50例行手术治疗,其中乙状结肠单纯复位15例,乙状结肠复位后固定6例,一期切除吻合术19例,10例行一期坏死肠袢切除结肠造口、二期降结肠直肠吻合术。治愈53例,死亡4例,复发2例。结论：老年腹痛、腹胀和便秘应考虑本病的可能。X线为首选检查。对于无肠坏死及腹膜炎的患者,行结肠镜检查有明显优点,对于有肠坏死及腹膜炎的患者,应及时手术治疗,一期肠切除吻合术宜慎用。     

乙状结肠扭转43例临床分析

为探讨乙状结肠扭转的临床表现、术前诊断和治疗方法,回顾分析1991～2012年我院收治的43例乙状结肠扭转患者的病史、临床表现、影像学检查、术中所见及手术方法。结果显示,本组男：女为3．8：1;年龄46～81岁,其中60岁以上25例;32例有便秘史;顺时针与逆时针肠扭转之比为1．9：1;术前经影像学检查确诊35例,8例经剖腹探查证实为乙状结肠扭转;35例行乙状结肠复位、固定术,6例行乙状结肠切除一期吻合术,2例行乙状结肠切除加降结肠造口术;术后无吻合口漏发生,创口感染6例;随访1年,均无复发。结果表明,乙状结肠扭转多见于老年男性,多有便秘病史,术前根据影像学检查和临床表现基本可明确诊断,主要采用手术治疗,术式选择应根据患者全身情况及肠管的局部情况而定。     

乙状结肠扭转诊断和急诊治疗的临床分析

目的探讨乙状结肠扭转的诊断和急诊治疗,总结临床经验以提高诊治水平。方法对49例乙状结肠扭转患者进行相应临床诊治,记录相关资料以做回顾性分析。结果 49例患者中46例痊愈,3例死亡。治愈患者住院时间为13～21 d,其中切口感染4例,肺部感染3例,经过支持、对症治疗后症状缓解。术后l周内l例因肺部感染及严重心律失常死亡,l例因吻合口瘘死于感染性体克,1例因自身严重疾病而死亡。结论经过及时诊断和急诊治疗乙状结肠扭转患者大都能脱离生命危险,治愈出院。由于多为老年患者,容易发生并发症。     

乙状结肠扭转手术治疗体会

乙状结肠扭转手术治疗体会王诗建我院外科１９８４年１月～１９９４年１月共收治乙状结肠扭转３２例，急诊手术治疗，其中２８例无肠坏死者行复位缩短固定术，取得良好结果。现报告如下。临床资料一、一般情况：本组３２例中，男２４例，女８例，年龄２１岁～８３岁，其中...     

乙状结肠扭转46例临床分析

乙状结肠扭转４６例临床分析曾敦述朱子健乙状结肠扭转是急性肠梗阻的常见病因之一。该病多见于老年患者，术后并发症多，病死率较高，且复发率高。我院自１９８７年５月～１９９７年５月间共收治乙状结肠扭转病例４６例。现报告如下。１临床资料１．１一般资料本组男３７...     

48例乙状结肠扭转的病因诊断及治疗

目的探讨乙状结肠扭转的病因、诊断及治疗方法。方法对1995年1月至2010年12月诊治的48例乙状结肠扭转的临床资料进行回顾性分析。结果术前通过病史、临床症状、体征及影像学检查明确诊断36例（75.0%）,误诊12例（25.0%）。行手术治疗40例（83.3%）,非手术治疗8例（16.7%）。治愈46例（95.8%）,围手术期死亡2例（4.2%）。本组获随访患者36例（75.0%）,随访最长时间15年,最短时间6个月。手术治疗的患者中有7.5%（3/40）复发,非手术治疗50.0%复发（4/8）;病死率22.2%（8/36）。结论本病的诊断主要依靠临床表现、腹部X线及CT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。     

Laparoscopy in the management of closed loop sigmoid volvulus

Objective To investigate the feasibility and surgical outcome of elective laparoscopic surgery for acute closed loop sigmoid volvulus. Method A prospectively electronic database of colorectal laparoscopic procedures identified nine consecutive patients with sigmoid volvulus managed by colonoscopic decompression followed by same admission laparoscopic recto‐sigmoidectomy. Results Between January 2001 and February 2007, nine patients, ASA I (one), II (four), III (four) with sigmoid volvulus were treated: seven were women. Their age distribution was 37–87 years (median 64). The volvulus was the first episode in one patient, the second episode for four and the third (or more) for the remainder. The median operation time was 115 min (45–145). No anastomosis was de‐functioned. Postoperative analgesia was parenteral paracetamol (eight) supplemented by 10 mg oral morphine in one case; a ninth patient received patient controlled parenteral morphine for 36 h. Complications included: ileus (one), myocardial infarct (one) and wound infection (one). There was one death on day 32 from a brainstem infarct. Seven had an uncomplicated recovery. The median postoperative stay was 4 days (2–32). Conclusion Laparoscopic recto‐sigmoidectomy postcolonoscopic decompression is a good option for patients with sigmoid volvulus. Surgical complications are minimal and recovery is quick.     

Colonoscopic treatment of sigmoid volvulus

Summary Sigmoid volvulus commonly presents with signs of bowel obstruction. In the absence of an exact preoperative diagnosis, these patients have to undergo urgent surgery. We report a case of sigmoid volvulus diagnosed radiologically and managed by endoscopic derotation. When the cause of the obstruction is known to be due to sigmoid volvulus, surgery can be avoided by careful endoscopic derotation of the sigmoid colon.     

Single-stage procedure in management of uncomplicated acute sigmoid volvulus without colonic lavage

Aim: The management of sigmoid volvulus remains controversial. We aimed to evaluate the postoperative outcome of patients with acute non-complicated sigmoid volvulus managed with resection and anastomosis without preoperative colonic lavage. Methods: From January 2007 to December 2009, 40 patients with uncomplicated sigmoid volvulus underwent bowel decompression, resection and anastomosis without preoperative mechanical colonic preparation. Results: A total of 40 patients underwent the procedure, one patient developed anastomotic leak. Wound infection was reported in three patients, one death was a result of respiratory failure. Conclusion: Surgical management of sigmoid volvulus in one step without preoperative colonic lavage is a safe procedure and is recommended for acute cases.     

乙状结肠扭转的CT诊断(附23例分析)

目的:探讨乙状结肠扭转的多排螺旋C T表现特征。方法:回顾手术中证实为乙状结肠扭转的23例,分析腹部C T扫描图和横断面扫描特征,总结乙状结肠扭转的C T影像学特征。结果:在C T定位像上,最敏感的表现是扩张的乙状结肠倒U征(21/23,91%),不成比例乙状结肠扩张(19/23,83%),其次为咖啡豆征(17/23,74%),Y征(12/23,52%)。在横断面扫描上,最敏感的是不成比例的乙状结肠扩张(21/23,91%)和圆腹征(20/23,87%),其次为近端结肠扩张(15/23,65%),漩涡征(15/23,65%),鸟嘴征(13/23,57%)。在C T定位像和横断面扫描上,典型的乙状结肠扭转影像表现分别占57%(13/23)和83%(19/23)。在定位像上,咖啡豆征与Y征在显著相关(P0.05)。横断面扫描上肠管损害的C T征象与临床肠管损害显著相关(P0.05)。结论:多排螺旋C T对乙状结肠扭转的诊断具有重要价值。在定位像上,乙状结肠扭转的主要影像学表现为倒U征,特征性表现为Y征;在横断面扫描上,主要影像学表现为不成比例的乙状结肠扩张,特征性表现为漩涡征和鸟嘴征。     

Recurrent sigmoid volvulus in a sixteen-year-old boy: case report and review of the literature

The authors describe a 16-year-old boy in whom 3 episodes of sigmoid volvulus (SV) occurred over a period of 7 weeks, each time reduced by endoscopy. The child subsequently underwent a successful sigmoid resection with primary anastamosis. Several months after surgery, he remains free of symptoms and is doing well. A review of the literature illustrates the approach to this problem from ancient times until now.     

Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus

Background The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus. Methods Patients with sigmoid volvulus were first offered colonoscopic decompression for their acute colonic obstruction. If the colonic decompression was successful, complete bowel preparation was performed, followed by elective laparoscopically assisted sigmoidectomy. The details of the laparoscopic procedures are shown in the video. Briefly, the redundant sigmoid colon is totally mobilized by a laparoscopic medial-to-lateral dissection sequence, after which it is exteriorized, transected, and reconstructed by end-to-end anastomosis. In the authors’ experience, the medial-to-lateral approach is highly efficient for the laparoscopic mobilization of the redundant sigmoid colon. We believe that the longer the lateral abdominal wall attachment of the sigmoid colon is preserved, the better the exposure and the easier the dissection. If the risk of anastomotic leakage is considered high in a specific case, protective ileostomy is selectively preformed. Before entering the current study, the patients were well informed about the advantages and disadvantages of laparoscopic surgery. The enrollment of patients was selective according to the appropriate eligibility criteria. This study was approved by the Institutional Review Board of the National Taiwan University Hospital. The patients’ clinicopathologic data and surgical outcomes were prospectively evaluated. Results Between August 2001 and April, 2005, a total of 14 patients (10 men and 4 women) with sigmoid volvulus were treated with the described procedure. The age distribution of the patients was 68.4 ± 12.2 years. The attack of sigmoid volvulus was the first episode for eight patients, the second episode for 4 patients, and the third episode (or more) for two patients. The body mass index (BMI) of the patients was 26.8 ± 4.4 kg/m². The physical status (classification of American Society of Anesthesiology [ASA]) was 1 for five patients, 2 for eight patients, and 3 for 1 patient. During the laparoscopy, all the patients presented with the pathognomonic findings of sigmoid volvulus including redundant sigmoid colon, narrow sigmoid mesenteric pedicle, and mesosigmoiditis with mesenteric fibrosis and scarring, as shown in the video. The length of the resected colon was 32 ± 6 cm. The operation time was 194.6 ± 32.4 min, and the blood loss was 44.0 ± 12.4 ml. The abdominal wound consisted of four 5- to 12-mm working ports and a 5-cm major wound for exteriorization of the sigmoid colon. Some surgeons have shown that a sigmoid volvulus can be resected through a 5-cm left lower quadrant incision with very little mobilization of the colon because of its redundancy. In this context, the laparoscopic approach competed with the minilaparotomy method in terms of adequate sigmoid resection, lysis of mesosigmoid adhesion, and tension-free colorectal anastomosis. Protective ileostomy was performed for the only patient with a physical status of ASA 3. There was no mortality in this case series. However, pneumonia developed postoperatively in one patient, acute myocardial infarction in one patient, and wound infection in two patients. Excluding the two patients who experienced postoperative pneumonia and acute myocardial infarction, the duration of the postoperative ileus was 48 ± 12 h, the postoperative hospitalization was 7 ± 1 days, and the degree of postoperative pain was 3.5 ± 0.5 according to the visual analog scale. The return to partial activity required 18 ± 2.5 days, and the return to full activity required 28.4 ± 5.6 days. As compared with the overall costs for a conventional sigmoid colectomy, which are completely covered by the National Bureau of Health Insurance of Taiwan, the expenses for the patients undergoing laparoscopic procedures were significantly higher by approximately NT$24,000.0 ± 2,635.0 (1 U.S. dollar = 32 NT$). These higher expenses must be borne by the patients themselves. Conclusion Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence. This article contains a supplementary video.