结肠穿孔22例临床诊治体会

Diagnosis and treatment of colonic perforation (report of 22 cases)

目的探讨不同病因致结肠穿孔的手术方式及治疗方法。方法对22例不同原因的结肠穿孔手术患者的临床资料进行回顾分析。结果 22例中死亡5例(占22.7%)。3例自发性乙状结肠穿孔中2例行破裂肠管切除、远端关闭、近端结肠造口术,死亡1例。1例纤维结肠镜检致横结肠穿孔,行肠穿孔裂孔修补术。11例癌性结肠穿孔:4例采用Ⅰ期切除吻合,7例分期手术,其中死亡3例。1例乙状结肠扭转肠坏死穿孔,经分期手术而治愈。6例外伤性结肠破裂:3例采用Ⅰ期切除吻合,2例分期手术治愈,死亡1例。结论 结肠穿孔的手术方式是决定预后的关键,治疗上应当个体化,需根据患者全身情况、腹腔污染程度、穿孔病因来决定手术的方式。

Objective To discuss surgical procedures and treatment of colonic perforation caused by different diseases.Methods The clinical data of 22 patients with colonic perforation were analyzed retrospectively.Results Operative mortality occurred in 5 of 22 cases.Three cases were spontaneous colonic perforation,of which two cases underwent resection of colon segment involved,closure of distal end and colostomy,one died. One patient who was perforation of transverse colon by fibrocolonoscope was treated by single suture.Eleven cases were cancerous perforation of colon： four cases cured by primary anastomosis,seven cases by staging operation,of which three cases died.One patient who was colonic perforation by volvulus of sigmoid colon was cured by staging operation.Six cases were traumatic colonic perforation： three cases cured by primary anastomosis,two cases by staging operation,one died.Conclusions The key to determine prognosis is surgical procedures of colonic perforation.Operation combined with individualized therapy should be based on patient′s condition,pollution in the abdominal cavity,and causes of colonic perforation.