非外伤性结肠穿孔13例诊治的临床分析

The clinical analysis of 13 cases of spontaneous perforation of colon

目的:通过分析非外伤性结肠穿孔的病因、诊断及治疗,提高该病的诊治水平。方法:回顾近10年间收治的非外伤性结肠穿孔13例患者的临床资料。患者均急诊行剖腹探查手术,13例患者中11例行结肠造瘘,其中穿孔部位直接外置双腔造瘘或切除病变肠管后远近段肠管双腔造瘘共4例,修补穿孔近段肠管造瘘4例,Hartmann术3例;1例Ⅰ期修补;1例行右半结肠切除后Ⅰ期吻合。结果:自发性穿孔8例,结肠癌性穿孔4例,乙状结肠由于田鸡骨头致穿孔1例;1例术后感染性休克昏迷家属放弃治疗,2例术后病情稳定自动出院到外院进一步治疗,其他10例均治愈出院。结论:非外伤性结肠穿孔老年患者多见,缺乏特异性表现,误诊率较高,早期诊断和及时恰当的手术是治疗的关键。

Objective： To investigate the etiology,diagnosis and therapy of spontaneous perforation of colon,so as to improve the level of diagnosis and treatment of the disease. Methods： The clinical data of 13 cases of spontaneous perforation of colon in 10 years were analyzed retrospectively. All cases underwent emergency exploratory laparotomy. Among all cases,colostomy was performed in 11 cases,direct external double luminal colostomy of the perforated colon or double luminal colostomy in the distal and proximal segment after the resection of the affected bowel in 4cases,suture of perforated proximal segment in 4 cases,Hartmann in 3 cases,Ⅰstage suture of perforation in 1 case,and focal excision and primary enteroanastomosis in the right hemicolon in 1 case. Results： There were 8 cases of spontaneous perforation,4 cases of carcinomatous perforation and1 perforation of the sigmoid colon induced by frog bones. 1 case of infectious shock was abandoned by the patient＇s families,2 cases in stable condition after operation discharged to other hospital for further treatment,and the other 10 cases were cured. Conclusion： Spontaneous perforation of the colon,which is common in the elderly,has a high misdiagnosis rate due to the lack of specific performance. Early correct diagnosis and appropriate surgical treatment are vital for its treatment.