结肠镜术并发肠穿孔的诊断与处理

Diagnosis and treatment of colonoscopic perforation

结肠镜已成为目前诊治结直肠疾病最常用的方法。尽管肠穿孔与医源性因素及患者某些高危因素有关，发生率较低，但被认为是结肠镜术严重的并发症之一，病死率高。根据结肠镜术中或术后患者的临床表现，早期发现肠穿孔是成功治疗的前提，也是降低病死率的关键。在治疗上有保守治疗、开腹手术、腹腔镜手术及内镜夹等多种方法。临床上应具体分析和准确判断病情，不能一概而论，根据患者的临床表现、穿孔大小、肠道准备情况、确诊时间、结肠原发病变等具体临床条件选择合理有效的治疗方案。

Colonoseopy has become the most commonly used method to the diagnosis and treatment of colorectal diseases at present. Colonoscopie perforation is considered the most serious complication with high mortality, especially in the patients with certain risk factors and iatrogenic factors, despite of its low incidence. According to the clinical features in the period of perioperative eolonoscopy, early detection of colonoscopic perforation is a prerequisite for successful treatment and the key to lower mortality. So far in the treatment, some methods can be selected, including conservative treatment, open surgery, laparoseopic surgery and endoscopy folders, etc. Clinical judgement and analysis of disease should be specific and accurate, but not to be generalized. Doctors should adopt reasonable and effective treatment options according to clinical performance, the size of perforation, intestinal readiness, time of diagnosis, colon primary lesion and so on.