乙状结肠自发性穿孔的诊治分析

Diagnosis and treatment of spontaneous perforations of the sigmoid colon

目的探讨自发性乙状结肠穿孔的临床诊断和治疗方法。方法回顾性分析自发性乙状结肠穿孔16例患者的临床资料,总结有关诊断和治疗问题。结果本组平均年龄67.8岁,伴有高血压9例,慢性支气管炎11例,前列腺增生7例,糖尿病6例,16例均经手术及病理报告而明确诊断,术前误诊率为81.2%。术后发生切口感染裂开、肺部感染吻合口瘘等并发症9例,12例治疗痊愈出院;死亡4例(25%)中主要死于肺部感染及感染中毒性休克。结论乙状结肠自发性穿孔多发于老年患者,合并症多、误诊率高、病死率高。应提高对老年急腹症的认识,认真询问病史,早诊断、早手术是治疗本病的根本措施,正确处理穿孔、彻底清洗、充分引流、治疗合并症是治疗该病的关键。

Objective To evaluate the clinical characteristics, diagnosis and treament in patients with spontaneous perforations of the sigmoid colon. Methods Clinical data and pathological materials of 16 patients with spontaneous perforations of the sigmoid colon, who were treated in Guangxi Napo County People＇s Hospital, were reviewed. Results The patient＇ s average age in our study was 67.8 years old, 9 patients accompanied with hypertension, 11 patients with chronic bronchitis,7 patients with prostatic hyperplasia, 6 patients with DM. The sixteen patients who was diagnosed by surgery and pathology, the misdiagnostic rate was 81.2%. The postoperative complications occurred in 9 patients, including incision disruption, anastomotic leakage, wound infection and lung infection. Twelve patients were healed well except 4 patients died from lung infection and toxic shock after operation. Conclusion Spontaneous perforation of sigmoid colon is noteworthy due to its more complications, high misdiagnosis rate and high mortality rate in elderly patients. It is important to raise awareness of the acute abdomen. The best way to treat the spontaneous perforations of the sigmoid colon is careful history taking, early diagnosis and treatment. For the treatment of spontaneous perforations of the sigmoid colon, correct perforation treatment, thorough cleaning, adequate drainage and treatment of related complications are critical.