赞比亚34例次乙状结肠扭转的急诊手术治疗体会

Emergency surgery of sigmoid volvulus: a retrospective study of thirty-four cases in Zambia

目的总结乙状结肠扭转高发区的手术治疗经验。方法对LevyMuwanawasa综合医院2011年8月～2012年11月34例次成人乙状结肠扭转急诊手术患者的临床资料进行回顾性分析。术中发现乙状结肠扭转肠襻长约60～120cm，扭转肠襻坏死但未穿孔4例。其中行乙状结肠无术中灌洗一期切除吻合术32例次，乙状结肠扭转复位加肠管固定术1例，乙状结肠扭转单纯复位1例。结果2例手术复位患者坦院后1～3月，症状复发再次入院行乙状结肠一期切除吻合术。30例次急诊一期切除吻合术患者均一期痊愈；术后随访1～12月，未见复发。2例次术后并发吻合口瘘，二次剖腹探查发现与吻合口张力过高有关，行Hartmann术后因感染性休克而死亡。结论乙状结肠扭转且扭转肠襻较长患者应首选乙状结肠切除吻合术，急诊一期乙状结肠无术中灌洗切除吻合术对于未穿孑L乙状结肠扭转患者是可行的，无张力吻合是手术关键。

Objective To review the surgical management of acute sigmoid volvulus in a relatively high prevalence area. Methods Thirty-four adult cases with acute sigmoid volvulus seen at the Levy Muwanawasa general hospital （LMGH） Lusaka, between August 2010 and November 2012 were studied. All the cases had undergone emergency laparotomy. The length of twisted sigmoid loop ranged from 60 cm to 120 cm. 4 of 34 cases had gangrenous sigmoid colons without perforation. 32 cases had one-stage resection and primary anastomosis without on-table lavage, one case underwent intraoperative detorsion and another had detorsion detorsion plus sigmoidopexy. Results Two cases with intraoperational detorsion had recurrence 1 -3 months after discharge followed by emergent sigmoidectomy and primary anastomosis on the second admission. 30 cases with one-stage resection and primary anastomosis were fully recovered by first intention. No recurrence was found after 1-12 months of follow-up.2 cases had anastomotic leaks due to excessive stoma tension found at re-laparotomy. They had Hartmann＇s procedure and finally died of septic shock. Conclusion Sigmoid resection and primary anastomosis should be the first choice for patient with long twisted sigmoid loop. Resection of acute sigmoid volvulus and primary anastomosis without on-table colonic lavage can be carried out safely in patient without complication of perforation and the key to it may be tension-free anastomosis.