急性肠扭转并肠坏死患者12例临床分析
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摘要
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.
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.
引文
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[7] 仲兴阳,匡荣康.成人小肠扭转23例诊治分析[J].中国临床研究,2016,29(11):1550-1551.
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[12] 张帆,夏万泓,刘建军,等.多层螺旋CT多平面重建技术在急性肠梗阻病因诊断中的应用[J].广西医科大学学报,2016,33(3):503-506.
[13] Barabde M,Tiwari S,Lavankar V.Small bowel volvulus:a rare twist in an adult[J].2016,2(2):44.
[14] 刘大方,郝小强,叶颖江,等.急性肠系膜上动脉闭塞性疾病发生肠坏死的早期预测因素[J].中华普通外科杂志,2017,32(4):301-305.
[15] 陈肇平,熊诗俊,李清水,等.多层螺旋CT血管造影对小肠梗阻诊断的临床价值[J].临床放射学杂志,2017,36(2):257-259.
[16] 陈启仪,姜军.小肠梗阻诊断与治疗再认识[J].中华胃肠外科杂志,2017,20(10):1136-1140.
[17] Barabde M,Tiwari S,Lavankar V.Small bowel volvulus:a rare twist in an adult[J].Int J Sci Res,2016,2(2):44.
[18] Li X,Zhang J,Li B,et al.Diagnosis,treatment and prognosis of small bowel volvulus in adults:A monocentric summary of a rare small intestinal obstruction[J].PloS One,2017,12(4):e0175866.
[19] 邹劲林,凌志东,莫湘琼.成人全小肠扭转的临床分析[J].实用医学杂志,2018,34(19):176-178.
[20] 田晶,康星,汪灏,等.成人急性小肠梗阻的病因学分析[J].中华全科医学,2018,16(5):29-32.
[21] Leow JJ,Huey T,Low JK.Primary adult midgut volvulus mimicking acute appendicitis:A case report and review of the literature[J].Int J Surg Case Rep,2016,24:182-184.
[2] Moshe Schein.汤文浩译.Schein外科急腹症[M].科学出版社,2011:162-164.
[3] 夏穗生.腹外科急症诊断与治疗[M].世界图书出版公司,2003:159.
[4] Hsu CG,Berger A,Shulman A,et al.Intestinal necrosis with midgut malrotation and intermittent volvulus:presentation as acute abdominal pain in an adult[J].J Emerg Med,2016,51(3):326-328.
[5] 钱宏美,张勇.成人急性小肠扭转的诊治体会[J].临床急诊杂志,2016(2):159-160.
[6] 苏海巍.小肠扭转的早期诊断和治疗18例分析[J].医学信息,2015(40):412-413.
[7] 仲兴阳,匡荣康.成人小肠扭转23例诊治分析[J].中国临床研究,2016,29(11):1550-1551.
[8] 罗光华,赵衡,周宏,等.MSCT对急性小肠扭转诊断价值[J].中国临床医学影像杂志,2014,25(11):819-821.
[9] Gollub MJ,Yoon S,Smith LM,et al.Does the CT whirl sign really predict small bowel volvulus:experience in an oncologic population[J].J Comput Assist Tomogr,2006,30(1):25-32.
[10] Zalcman M,Sy M,Donckier V,et al.Helical CT sign in the dignosis of intestinal ischemia in small-bowel obstruction[J].Am J Roentgenol,2000,175(6):1601-1607.
[11] Yang T,Li J,Yang J,et al.The whirl sign and small intestinal volvulus[J].J Pediatr,2016,173(6):265.
[12] 张帆,夏万泓,刘建军,等.多层螺旋CT多平面重建技术在急性肠梗阻病因诊断中的应用[J].广西医科大学学报,2016,33(3):503-506.
[13] Barabde M,Tiwari S,Lavankar V.Small bowel volvulus:a rare twist in an adult[J].2016,2(2):44.
[14] 刘大方,郝小强,叶颖江,等.急性肠系膜上动脉闭塞性疾病发生肠坏死的早期预测因素[J].中华普通外科杂志,2017,32(4):301-305.
[15] 陈肇平,熊诗俊,李清水,等.多层螺旋CT血管造影对小肠梗阻诊断的临床价值[J].临床放射学杂志,2017,36(2):257-259.
[16] 陈启仪,姜军.小肠梗阻诊断与治疗再认识[J].中华胃肠外科杂志,2017,20(10):1136-1140.
[17] Barabde M,Tiwari S,Lavankar V.Small bowel volvulus:a rare twist in an adult[J].Int J Sci Res,2016,2(2):44.
[18] Li X,Zhang J,Li B,et al.Diagnosis,treatment and prognosis of small bowel volvulus in adults:A monocentric summary of a rare small intestinal obstruction[J].PloS One,2017,12(4):e0175866.
[19] 邹劲林,凌志东,莫湘琼.成人全小肠扭转的临床分析[J].实用医学杂志,2018,34(19):176-178.
[20] 田晶,康星,汪灏,等.成人急性小肠梗阻的病因学分析[J].中华全科医学,2018,16(5):29-32.
[21] Leow JJ,Huey T,Low JK.Primary adult midgut volvulus mimicking acute appendicitis:A case report and review of the literature[J].Int J Surg Case Rep,2016,24:182-184.