Experience with Volvulus of the Colon

處理大腸扭結之經驗

黃約翰(John Huang) ； 劉明松(Ming-Sung Liu) ； 梁金銅(Jin-Tung Liang) ； 王世名(Shih-Ming Wang) ； 張金堅(King-Jen Chang) ； 李伯皇(Po-Huang Lee)

《中華民國大腸直腸外科醫學會雜誌》 15卷4期 (2004/12) Pp. 113-118

https://doi.org/10.6312/SCRSTW.2004.15(4).09321

摘要

背景 大腸扭結是常見的良性大腸阻塞的原因之一。在這份研究報告中，我們將回顧處理大腸扭結的經驗。方法 自西元一九九四年至西元二OO四年間，所有診斷為大腸扭結的病例均以回溯性的整理。在這十年間，總共有三十個病例診斷為大腸扭結。結果 計有盲腸扭結四例，乙狀結腸扭結二十六例。所有盲腸扭結的病人均接受切除併直接接合手術。在二十六例乙狀結腸的病人當中，有十四位病人嘗試非手術性的減壓處理，當中有十三例成功。而總共有二十一位病人接受手術治療，當中包含了一位大腸鏡減壓失敗的病例，以及八例經成功減壓處理後接受開刀的病人。有六位病人接受開腹復位術，而有十五位病人接受大腸切除併接合。在只接受非手術性減壓術的乙狀結腸扭結病人中，有40%復發。而接受手術治療的盲腸扭結以及乙狀結腸扭結的病人中，沒有復發。在盲腸扭結的病人中，有一例死亡(25%)。乙狀結腸扭結病人接受開腹復位術的病人中，有兩例死亡(33.33%)。而在接受手術切除的病人中，有一例死亡(6.67%)。乙狀結腸扭結的整體死亡率是14.29%。結論 對於大腸扭結的病人，應該先嘗試使用非手術減壓法來處理，而手術治療可以減少復發率，但是必須承擔比較高的風險。

關鍵字

大腸扭結 ； 大腸阻塞 ； 手術治療 ； 減壓處理

並列摘要

Background. Colonic volvulus is one of the most common benign causes of colon obstruction. In the present study, we review our experience with colonic volvulus. Method. Themedical records of patientswith a diagnosis of colonic volvulus during the period of 1994 to 2003 are reviewed retrospectively. During this 10-year period, 30 patients were diagnosed with colonic volvulus. Results. Four patients had cecal volvulus, and 26 patients had sigmoid volvulus. All four patients with cecal volvulus underwent resection and primary anastomosis. Of the 26 patients with sigmoid volvulus, nonoperative decompression was attempted in 14 patients, and in 13 of them the procedure was successful. Twenty-one patients underwent an operative procedure, including one failed colonoscopic decompression and eight elective operations after successful nonoperative decompression. Six operative reductions were performed, and 15 resections with anastomosis were performed. The recurrence rate was 40% in patients with sigmoid volvulus underwent nonoperative decompression alone. There was no recurrence in cecal or sigmoid volvulus when operative procedures were undertaken. One patient of cecal volvulus expired (25%). Two patients with sigmoid volvulus expired in the reduction group (33.33%), and one patient expired in the resection group (6.67%). The overall mortality was 14.29% with sigmoid volvulus. Conclusions. In patients with colonic volvulus, nonoperative decompression should be performed initially, and operative procedures provide a low recurrence rate with substantial risk.

並列關鍵字

Colonic volvulus ； Colonic obstruction ； Surgical intervention ； Decompression procedure