乙状结肠自发性穿孔的诊治体会

Diagnosis and treatments of the spontaneous perforation of the sigmoid colon

目的探讨乙状结肠自发性穿孔的病因、临床表现及处理原则。方法回顾性分析根据手术及病理报告而明确诊断的14例乙状结肠自发性穿孔患者的临床资料。结果 14例患者平均年龄68岁,均有不同程度的慢性习惯性便秘,其他合并症有高血压、糖尿病。本组术前误诊率达92.8%。均予以手术治疗,其中10例行Hartmann手术,2例行穿孔处外置双腔造瘘术,1例行穿孔修补加近端双腔造瘘术,1例行穿孔修补加近端盲肠置管减压术。14例中8例治愈,6例死亡,死亡率为42.8%。结论乙状结肠自发性穿孔的误诊率、死亡率高,及时而合理的手术治疗是降低乙状结肠自发性穿孔死亡率的关键。

Objective To investigate the etiology, clinical manifestations and treatment principles of the spontaneous perforation of the sigmoid colon. Methods Retrospective analysis of surgical and pathology reports according to a clear diagnosis of spontaneous perforation of the sigmoid colon of 14 patients with clinical data. Results 14 patients had varying degrees of chronic habitual constipation, and other complications of hypertension, diabetes. The preoperative misdiagnosis rate was 92.8%, all to be surgical treatment, Hartmann operation in 10 cases, 2 cases perforation external double-lumen gastrostomy, a routine repair and perforation of the proximal double-lumen gastrostomy, a routine repair and proximal cecum perforated tube decompression. Of 14 patients, 8 patients were cured, 6 patients died, the mortality rate was 42.8%. Conclusion Spontaneous perforation of the sigmoid colon misdiagnosis rate, and mortality rate are high, timely and reasonable surgical treatment is the key to reduce mortality of spontaneous perforation of the sigmoid colon.