纤维结肠镜在结肠梗阻的病因诊断和治疗中的价值

Value of Colonofiberscope in the Etiological Diagnosis and Treatment of Colonic Obstruction

目的:探讨纤维结肠镜在结肠梗阻时的应用价值,旨在为临床合理选择提供参考。方法:回顾性分析经钡灌肠检查诊断为结肠梗阻而住院的患者56例,其中结肠癌46例手术治疗,结肠扭转5例中1例手术,4例肠镜复位,粪便嵌塞4例保守治疗,空肠粘连性梗阻1例手术。结果:死亡3例(7.14%),1例盲肠癌伴梗阻,2例乙状结肠癌伴梗阻,均死于术后24h内,死亡原因为多器官功能衰竭。无吻合口漏发生,切口感染3例,切口裂开1例,造口出血2例,造口狭窄4例,肺部感染6例。平均随访时间20个月。发现大肠息肉8例14枚,全部高频电切或钳除,无肿瘤复发。结论:结肠梗阻时急诊肠镜检查通常是安全的,对于明确病因,选择合理的治疗措施极其重要。

Objective：Obstruction of colon is the common emergency with multiple causes. This study focused on the value of colonofiberscope application in the obstruction of colon. Methods：Fifty-six cases with obstruction of colon diagnosed by barium enema were analyzed retrospectively. Among them, forty-six patients with colonic carcinoma underwent operation, 5 cases of colonic torsion were repositioned with colonofiberscope （4 cases） or operated, 4 cases of fecal impaction were treated conservatively, and one case of adhesive obstruction of jejunum was operated. Results：Three cases of ileus with colonic carcinoma died of multiple organ dysfunction within 24h postoperation. There were 3 cases of infection of incision, 1 case of disruptiong of wound, 2 cases of stoma bleeding, 4 cases of stoma stenosis, 6 cases of pulmonary infection. No anastomosis leak occurred. Mean follow-up period was 20 months. Fourteen polyps identified by colonofiberscope were resected endoscopiclly. No tumor recurrence was found. Conclusion： Emergency colonofiberscope is a safe examination for colonic obstruction. It is very helpful to identify the cause and to select reasonable treatment.