摘要
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。
Objective To summarize our experience with the diagnosis and treatment of sigmoid volvulus. Methods The clinical and management of 27 cases with sigmoid volvulus were analyzed and literatures reviewed. Results 16 cases were diagnosed by roentgenograms of the abdomen, 6 by colonoscopy, 4 by laparotomy, and one case was misdiagnosed as “gastrectasia”. 16 cases underwent non operative detorsion ,12 cases succeeded without any complications.15 cases were performed laparotomy (8 cases detorsion and colopexy,7 cases one-stage resection and anastomoses).One case with severe diabetes mellitus died from pulmonary infection and arrhythmia after operation. No anastomoses leak occurred. Conclusion Elder male patient with complaint of abdominal pain, distention and constipation should be suspected sigmoid volvulus. About 60% of cases could be diagnosed by roentgenograms. Colonoscopy has significant virtues to the cases without peritonitis and gangrenous bowel, and detorsion can be performed with high successful rate and low risk as soon as diagnoses are available. Laparotomy should be performed in time if non operative detorsion are failed or cases have peritonitis or gangrenous bowel.
