选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习
Colectomía derecha laparoscópica electiva por vólvulo cecal: reporte de un caso y revisión de la literatura
Elective laparoscopic right colectomy for caecal volvulus: case report and literature review

Abstract
摘要
Background
背景
Caecal volvulus is an uncommon cause of intestinal obstruction. Its clinical presentation is non-specific, with the diagnosis usually confirmed by barium enema and abdominal computed tomography. Treatment depends on many factors, and minimally invasive approaches are becoming the treatment of choice.
盲肠扭转是一种罕见的肠梗阻的原因。它的临床表现是非特异性的，诊断通常通过钡剂灌肠和腹部计算机断层扫描。治疗取决于许多因素，微创治疗成为首选的治疗方法。

Clinic case
临床案例
A 54 years old female, admitted to the Emergency Department with clinical symptoms of intestinal obstruction. On physical examination she had a palpable, firm, and tympanitic mass in the right abdomen, with peritoneal irritation. The radiographs of the abdomen, barium enema and abdominal computed tomography showed caecal volvulus. As she showed a full remission after the barium enema, with no clinical or biochemical data of systemic inflammatory response syndrome or peritoneal irritation, she was discharged to her home. Two weeks later, a laparoscopic right hemicolectomy was performed with an ileo-transverse extracorporeal anastomosis. Her progress was satisfactory, and she was discharged 4 days after surgery due to improvement.
一位54岁的女性，住进急诊科，有临床症状的肠梗阻。体检时她有一个显而易见的，坚定的，在右腹部臌胀的肿块，伴腹膜刺激。腹部的X线平片、钡灌肠及腹部电脑断层扫描显示盲肠扭转。由于她在钡灌肠后表现完全缓解，没有全身性炎症反应综合征或腹膜刺激的临床或生化数据，她出院回家了。两周后，腹腔镜右半结肠切除术和回肠吻合术进行横向体外吻合。她的进展是令人满意的，她在手术后4天，由于改善出院。

Conclusion
结论
Caecal volvulus is a rare cause of intestinal obstruction, with high mortality rates, and is caused by excessive mobility of the caecum. Its incidence is increasing. Treatment depends on many factors. Early non-surgical untwisting, followed by an elective laparoscopic surgical procedure offers several advantages and reduces mortality.
盲肠扭转是肠梗阻的罕见病因，死亡率高，是由盲肠过度的流动性造成的。其发病率增加。治疗取决于许多因素。早期非手术解除梗阻，其次是为择期腹腔镜手术提供了几个优势，降低死亡率。

Keywords
关键词
Caecal volvulus; Computed tomography of the abdomen; Laparoscopic colectomy; Elective surgery
盲肠扭转；腹部计算机断层摄影术；腹腔镜结肠切除术；选择性外科手术

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

Figura 1.
Placa simple de abdomen de pie con dilatación cecal (flecha negra), niveles hidroaéreos (flechas blancas) y ausencia de aire en ámpula rectal (flecha negra punteada).
图1.简单腹部站立与盲肠扩张（黑色箭头），空气流体水平（白色箭头）和直肠壶腹没有空气的条件（黑色虚线箭头）。

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

Figura 2.
Colon por enema donde se observa imagen en grano de café (flechas blancas).
图2.结肠灌肠，观察到的咖啡豆样图像（白色箭头）。

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

Figura 3.
Tomografía de abdomen. Corte axial con dilatación cecal, nivel hidroaéreo, sin evidencia de neumatosis intestinal ni líquido libre.
图3.腹部CT扫描。轴向切割盲肠扩张，液位没有肠道积气或游离液体的证据。

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

Figura 4.
Laparoscopia final donde se observa íleo transverso anastomosis latero lateral.
图4.腹腔镜横结肠梗阻端侧吻合观察到的很少。

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

Figura 5.
Esquema que ilustra el vólvulo cecal con torsión axial del ciego, colon ascendente e íleon terminal.
图5.
盲肠扭转模式说明了盲肠轴向扭转，升结肠及回肠末端。

选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习

Figura 6.
Esquema que ilustra la báscula cecal donde se produce un punto de flexión del ciego hacia arriba y anterior del colon ascendente, que provoca un mecanismo valvular de oclusión.
图6.
方案说明发生在盲肠的一点向上弯曲前盲升结肠的机制，导致瓣膜闭塞。

原文：
Colectomía derecha laparoscópica electiva por vólvulo cecal- reporte de un ca.pdf (1.5 MB, 下载次数: 0, 售价: 99 香叶)

2016-8-29 08:04 上传

点击文件名下载附件
选择性腹腔镜结肠切除右盲肠扭转--病例报告及文献复习