急性肠扭转并肠坏死患者12例临床分析

Clinical Analysis of 12 Cases of Acute Volvulus and Intestinal Necrosis Patients

目的:探讨、分析肠扭转的临床表现、影像诊断及治疗原则。方法:对2014年5月至2018年2月河南科技大学第二附属医院和郑大一附院急诊科收治的12例急性肠扭转患者的临床资料进行回顾分析。结果:12例均行多层螺旋CT(MSCT)检查,并发现不同程度腹腔积液,其中6例见典型“漩涡征”,腹腔穿刺抽出血性腹水4例。剖腹探查确诊5例,原发性肠旋转不良小肠扭转1例,继发性小肠扭转10例,乙状结肠扭转1例,腹腔术后粘连为主要继发病因,有9例(75%)。不同程度肠坏死10例,扭转角度270°~720°,平均(320±35)°。12例患者均行急诊剖腹手术治疗,10例治愈,肠功能恢复出院,2例死亡。结论:成人肠扭转起病急,症状重,早期可发生肠坏死、中毒休克,病死率高,预后差;全腹盆MSCT检查对该病诊断价值高;早期急诊剖腹探查手术,能显著提高本病治愈率,确诊及怀疑本病应立即剖腹急诊手术。

Objective:To explore and analyze the clinical manifestations,imaging diagnosis and treatment principles of volvulus.Methods:Retrospectively analysis of clinical data of 12 patients with acute volvulus treated in the emergency department of the Second Affiliated Hospital of Henan University of Science and Technology and the First Affiliated Hospital of Zhengzhou University from May 2014 to February 2018.Results:All the 12 cases of patients underwent multislice spiral CT(MSCT)examination and found different degrees of ascites,of which 6 cases had typical"whirlpool sign".4 cases had hemorrhagic ascites by abdominal puncture.5 cases were diagnosed by exploratory laparotomy,1 with small bowel torsion in primary bowel rotation,10 with secondary small bowel torsion,1 with sigmoid colon torsion,and postoperative adhesions in the abdominal cavity was the main secondary causes(9 cases,75%).There were 10 cases of intestinal necrosis of varying degrees,and the torsion angle was 270°to 720°with an average of(320±35)°.12 patients underwent emergency laparotomy,10 patients were cured and discharged from the hospital,and 2 patients died.Conclusion:Adult volvulus has the characteristics of acute onset,severe symptoms,early intestinal necrosis,toxic shock,high mortality,and poor prognosis.MSCT examination of the entire abdominal cavity is of high diagnostic value.Early emergency exploratory laparotomy can significantly improve the cure rate of the disease.Timely emergency laparotomy is necessary when the disease is diagnosed and suspected.