自发性结肠穿孔临床分析(附13例报告)

Clinical analysis of spontaneous perforation of colon: a report of 13 cases

目的探讨自发性结肠穿孔的病因及诊疗策略。方法对我院2000—07-2012—07收治的13例自发性结肠穿孔患者的临床资料进行回顾性分析。结果本病以老年患者多见，常伴有习惯性便秘、糖尿病、高血压等疾病，需急诊手术治疗。13例患者均经手术探查证实为自发性结肠穿孔，术前误诊10例，误诊率76．9％。行结肠穿孔修补术1例，穿孔段结肠外置造瘘2例，穿孔修补＋近端结肠造瘘6例，病变段结肠切除＋近端结肠造瘘4例。11例患者治愈，治愈率84．6％，2例死亡，死亡率15．4％。结论自发性结肠穿孔临床上缺乏特异性表现，确诊率低，预后差。早期正确的诊断和及时恰当的手术方式是提高治疗效果的关键。

Objective To explore the etiology, diagnosis and treatment of spontaneous perforation of colon （SPC）. Methods The clinical data of 13 SPC cases administered to our hospital from July 2000 to July 2012 were retrospectively analyzed. Results SPC was commonly seen in the elderly with constipation, diabetes, hypertension, and it was the indication for emergency operation. All 13 ca- ses of SPC were finally diagnosed by exploratory operations. Of 13 cases, 10 cases were misdiagnosed before operations, and the misdiag- nosis rate was 76.9%. Of 13 cases, one case underwent the repair of colonal perforation,2 cases received double luminal colostomy of the perforated colon, 6 cases were treated by perforation repair plus proximal colostomy, and 4 cases were treated by resceting the perforated colon plus proximal colostomy. Finally, 11 cases （ 84.6% ） were cured and 2 cases （ 15.4% ） died. Conclusion Clinical clues are usually insufficient for supporting the diagnosis of SPC, resulting in high misdiagnosis rate and poor prognosis. The key to im- prove the prognosis depends on the accurate early diagnosis and the appropriate surgical therapy in time.