Volvulus of the Colon: Surgical Experience

大腸扭結之外科治療經驗

游耀東(Yau-Tong You) ； 張簡俊榮(Chung-Rong Changchien) ； 王正儀(Jeng-Yi Wang) ； 陳進勛(Jinn-Shiun Chen) ； 唐瑞平(Rei-Ping Tang) ； 江支銘(Jy-Ming Chiang) ； 謝寶秀(Pao-Shiu Hsieh) ； 葉建裕(Chien-Yuh Yeh) ； 蔡文司(Wen-Sy Tsai) ； 范仲維(Chung-Wei Fan) ； 洪

《Formosan Journal of Surgery》 39卷5期 (2006/10) Pp. 250-255

https://doi.org/10.29833/FJS.200610.0004

摘要

大腸扭結是腸阻塞的少數原因之一，有許多治療方法被提出。本研究分析大腸扭結不同治療方法的結果，從1982年至2004年共收集50个大腸扭結的病人，這些病人根據治療方法分成四組。第一組：10個病人，只接受大腸鏡減壓術；第二組：21個病人，先接受大腸鏡減壓術後再安排外科手術；第三組：12個病人，先接受大腸鏡減壓術後隨即再接受緊急外科手術；第四組：7個病人，接受緊急外科手術。在第一組，有7個病人再發生大腸扭結，須重複做大腸鏡減壓術；第二組，有1個死亡及1個併發症；第三組，有3個死亡及1個併發症；第四組，有3個死亡及2個併發症；整個死亡率為14%。本研究的結果發現，大腸鏡減壓術是治療大腸扭結的主要選擇方法，但是當病人情況適合時，則須進行扭結的大腸的切除手術。

並列摘要

Objective: Volvulus of the colon is a rare cause of intestinal obstruction that has had many types of management proposed over time. This study was designed to analyze results of various treatments through a review of patients with volvulus who were treated at our hospital.
Methods: A total of 50 patients diagnosed with volvulus of the colon between 1982 and 2004 was collected, and each was assigned to one of four groups according to the mode of treatment.
Results: Group 1 contained 10 patients who received colonoscopic decompression only; Group 2 contained 21 patients who underwent colonoscopic decompression followed by elective surgery; Group 3 contained 12 patients who received colonoscopic decompression followed by emergency surgery; and Group 4 contained 7 patients who underwent emergency surgery. Group 1 had no deaths, but the disease recurred in 7 of the 10 cases, requiring repeat colonoscopic decompression. Group 2, decompression followed by elective surgery, had one death and one patient who experienced significant morbidity (insufficiency of anastomosis requiring a diversion procedure). Group 3, decompression followed by emergency surgery, had three deaths and one patient with significant morbidity (with insufficiency of anastomosis requiring colostomy or ileostomy diversion). Finally, Group 4, initial emergency surgery, had three deaths and two patients with significant morbidity (colon obstruction and intra-abdominal abscess, each requiring an additional operative procedure for treatment). The overall mortality rate was 14% (7 of 50 patients).
Conclusions: Colonoscopic decompression is the technique of choice for reducing volvulus of the colon if the patient has not yet developed peritonitis. However, decompression should be followed by definitive colectomy with anastomosis when the patient is medically fit to undergo surgery.

並列關鍵字

colon volvulus ； colonoscopic decompression