特发性结肠坏死穿孔32例

Idiopathic perforation and necrosis of the colon: an analysis of 32 cases

目的:探讨特发性结肠坏死穿孔的临床特点.方法:回顾性分析32例特发性结肠坏死穿孔患者的发病诱因、临床特点和疗效.结果:32例患者中,以突发腹痛就诊26例,另6例先有腹部隐痛不适,渐发展为全腹痛,伴有腹胀.平均病程7.2h.临床表现为弥漫性腹膜炎26例(81.25%),局限性腹膜炎6例.23例既往有习惯性便秘史.术前仅确诊3例,误诊29例(81.25%),其中误诊为急性阑尾炎穿孔12例,上消化道穿孔11例,绞窄性肠梗阻9例.所有病例均行手术治疗,术中证实升结肠坏死2例,横结肠坏死4例,降结肠及乙状结肠坏死26例.26例痊愈出院;死亡6例(18.75%),4例死于感染中毒性休克,1例死于急性肺栓塞,1例死于并发肺部感染、呼吸衰竭.结论:仔细采集病史、详细体格检查、诊断性腹穿及CT检查对本病诊断极为重要;及早手术是治疗的根本措施,应正确处理坏死穿孔部位、彻底清洗腹腔,术后充分引流.

AIM： To investigate the clinical features of idiopathic perforation and necrosis of the colon. METHODS： The predisposing factors, clinical features and therapeutic outcomes in 32 cases of idiopathic perforation and necrosis of the colon were retrospectively analyzed. RESULTS： Of 32 patients with idiopathic per-foration and necrosis of the colon, 26 presented with sudden abdominal pain, and 6 suffered from abdominal pain or discomfort initially, which gradually developed into severe abdomi-nal pain and abdominal distention. The average disease duration was 7.2 h. The disease clini-cally manifested as diffuse peritonitis in 26 cases （81.25%） and localized peritonitis in 6 cases. Twenty-three patients had a past history of ha-bitual constipation. Only three patients were accurately diagnosed preoperatively, and 29 patients （81.25%） were misdiagnosed, of which 12 were misdiagnosed as acute appendicitis, 11 as upper digestive tract perforation, and 9 as strangulating intestinal obstruction. All patients underwent surgical treatment. The necrosis ofthe ascending colon was confirmed in 2 patients, the necrosis of the transverse colon in 4 patients, and the necrosis of the descending colon and sigmoid colon in 26 patients. Twenty-six patients recovered and were discharged from the hos-pital, and six （18.75%） patients died, of which 4 died of infection and toxic shock, 1 of acute pul-monary embolism, and 1 of pulmonary infection and respiratory failure. CONCLUSION： A careful review of past medi-cal history, detailed physical examination, di-agnostic paracentesis and CT examination are extremely important for accurate diagnosis of idiopathic perforation and necrosis of the colon. Early surgery is essential for good results.