老年人小肠扭转93例临床分析

Assessement of 93 examples of enteric volvulus in elderly patient

目的：探讨老年人小肠扭转临床特点，诊断方法和治疗效果。方法：对1998年10月-2007年10月手术治疗的93例老年人小肠扭转患者的临床资料进行回顾性分析。结果：经手术证实扭转最多发生在回肠远端距回盲部1m处，占45％。扭转肠襻均有血运障碍，其中12例肠坏死，伴肠穿孔3例。全组行肠切除肠吻合12例，其余行粘连解除＋肠腔减压＋复位等。90例治愈出院，死亡3例，死于多器官功能障碍综合征。结论：老年人小肠扭转缺乏肠管缺血症状，反应迟钝，体征不明显，病情轻重与病理变化不一致，常轻于组织学损害。为了及时诊断，在基层医院应提倡简单易行的两种方法：①动态地行X线腹部各方位检查。②腹腔穿刺对肠扭转有非常重要的诊断价值，抽出血性液体最有决定性意义。对此病一旦确诊应立即手术。

Objective： Discusses the features of enteric volvulus , the diagnostic method and the treatment effcet in elderly patients. Methods ： To review analyzse the clinical data of 93 enteric volvulus patients who operated in our hospital from Oct. 1997 to Oct. 2007. Resuits Confirmed by operation that the volvulus most occurred in the distal ileum where have one meter distance from ileocecus,accounting for 74per cent. Mostly, the volvulus fulcrum is the abdomen adhesion band, accounting for 45per cent. All the blood circulation of loxic intestinal loops have a barriers, Among these cases, there are 12 cases of intestinal necrosis, 3 cases of intestinal perforation. 12 patients＇intestinal was anastomosed after removal of bowel,The rest is desadhesion,intestinal cavity decompression,restoration and so on. 90 patients cured and discharged. 3 patients died of multiple organ dysfunction syndrome（MODS）. Conclusion： The elderly enteric volvulus lack of intestinal ischaemic symptoms, They are unresponsive and not obvious signs, The severity of illness and the changes of pathology is inconsistent. It often not serious than histology lesion. At the grassroots hospital,we should advocates two easy ways in order to the timely diagnosis：①Use dynanics of the abdominal X - ray to inspect all patients. ②The abdominocentesis have a very important diagnosic value to the enteric valvulus. Taking blood samples is of decisive significance. This disease once diagnosed,surgery should be immediately.