乙状结肠扭转57例的诊断及治疗

Diagnosis and Treatment of Acute Sigmoid Volvulus: A Report of 57 Cases

目的探讨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。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,有肠坏死及腹膜炎的患者应及时手术治疗,Ⅰ期肠切除吻合术宜慎用。

Objective To summarize the experience of the diagnosis and treatment of acute sigmoid volvulus. Methods The clinical situation and treatment of 57 patients with acute sigmoid volvulus were analysed retrospectively. Results 28 cases were diagnosed by X-ray photography. 19 cases were diagnosed by barium enema examination with clear 'beak'. 7 cases were diagnosed by Colonoscopy. Only 3 cases were diagnosed by exploratory laparotomy. And 4 cases were misdiagnosed or missed diagnosis. 9 patients received non-operative treatment and 7 were recovered. 50 cases were treated by operation. Among 57 cases, fifty-three cases were cured, but 4 cases died and 2 cases recrudesced. Conclusions Acute sigmoid volvulus should be taken into account when an elder man appeared abdominal pain, abdominal distention and constipation. X-ray is the preferred examination. Colosocopy is adequate for cases without colon necrosis or peritonitis. Operation should be performed in those patients with colon necrosis or peritonitis.Ⅰ-stage intestinal resection and anastomosis should be used carfully.