| 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. |
