老年人乙状结肠扭转的诊断与外科治疗

目的 总结老年人乙状结肠扭转的诊断与外科治疗经验。方法 对我院１０年来经手术治疗６０岁以上乙状结肠扭转１３例进行回顾性分析。结果 本病好发男性，临床表现为腹痛、腹胀、恶心呕吐、肛门停止排便排气１３例，左下腹隆起不对称１０例，１０例有长期便秘史，并内科性疾病８例。术前腹部Ｘ片确诊１１例。术中见全组乙状结肠冗长，肠坏死３例。２例行乙状结肠扭转复位侧腹膜固定，４例行Ｈａｒｔｍａｎｎ手术，３例行一期肠切除吻合，４例行乙状结肠切除双腔造瘘。术后无吻合口瘘。无死亡病例。结论 老年男性腹痛、腹胀、便秘应考虑本病，Ｘ线诊断准确性高。一经诊断宜早期手术，术式以一期肠切除最为理想，是否肠吻合，须具体情况灵活掌握，并应加强围手术期及内科疾病处理。

The Diagnosis and Surgical Treatment for Elder Patients with Sigmotd Volvulus

Objective To summarize the diagnosis and surgical treatment experience for elder patients with sigmoid volvulus.Methods The clinical data of 13 cases over sixty years old with sigmoid volvulus which underwent surgical treatment in recently ten years were analyzed retrospe ctively.Results The sigmoid volvulus is easily occurred in elde r male patients. The clinical manifestation were abdominal pain,distention,nau sea,no gas and feces expel from anus in 13 cases with constipation in 10 cases. Eight cases suffered from internal diseases. 11 cases were diagnosed by x-ray plain film. Sigmoid strangulated in 3 cases. The types of operation were detorsi on and colopexy in 2 cases,Hartmann in four cases,3 cases one stage resection and anastomosis,4 cases one stage resection and colostomy. All cases recoveri ed smoothly.Conclusion Elder male patient with abdominal pain, distention and constipation should be suspected sigmoid volvulus. One stage res ection sigmoid is the best operation. Anastomosis or not should consider general condition of patient.