成人结肠脾曲综合征102例的诊断与外科治疗

Diagnosis and surgical treatment of adult syndrome of splenic flexure of colon in 102 patients

目的总结成人结肠脾曲综合征（syndrome of splenic flexure of colon，SSFC）的诊断与外科治疗经验。方法对1989年7月至2010年10月收治的102例SSFC病人的临床资料进行回顾性分析。结果本组病人以反复发作性腹痛、腹胀及便秘并顽固性不全结肠梗阻为主要临床表现。98例x线钡剂灌肠造影显示结肠脾曲均较肝曲高7cm以上，迂曲成角〈45°，并横结肠冗长。行结肠脾曲松解术2例和结肠脾曲（上升支和下降支）侧侧吻合术3例，近期效果尚好，远期（6个月～2年）效果不良、症状复发；97例采用较彻底手术包括近段结肠大部切除术20例、结肠次全切除术28例、全结肠切除术39例，并发10例结肠癌，按根治性结肠癌切除术，术后均痊愈。结论根据临床特点和钡剂灌肠造影，可以明确诊断SSFC；应积极手术治疗，以近段、次全、全结肠彻底切除效果最佳。

Objective To summarize diagnosis and surgical treatment of adult syndrome of splenic flexure of colon （SSFC）. Methods The clinical data of SSFC in 102 patients between Jul. 1989 and Oct. 2010 were analyzed retrospectively. Results The main clinieal manifestations were repeated abdominal pain, abdominal distension, constipation and chronic incomplete colon obstruction. X-ray barium enema showed that splenic flexure of the colon was 7 cm higher than hepatic flexure of the colon. The angle of splenic flexure of the colon was less than 45°. Two patients underwent release of splenic flexure of the colon and 3 patients accepted side-to-side anastomosis of splenic flexure of the colon. The short-term effects of these methods were satisfactory, but long-term （6 months to 2 years） effects were unsatisfactory. As to the rest 97 patients, thorough operations were done： subtotal resection of proximal segment colon（20 cases）, subtotal resection of colon （28 cases） and total resection of colon （39 cases）. Ten cases complicated with colon cancer receiving radical resection were cured after surgery. Conclusion The diagnosis of SSFC is depended on clinical manifestations and barium enema. Thorough surgical treatment is the best method, including proximal part resection, subtotal resection and total resection of the colon.