结肠腹膜内穿孔26例诊治体会

Diagnosis and treatment of peritoneal perforation of colon:a report of 26 cases

目的总结结肠腹膜内穿孔的诊治经验。方法回顾分析我院2005年1月至2015年10月收治的26例结肠破裂患者临床资料。结果 26例结肠破裂患者中,由于结肠肿瘤性穿孔9例、肠镜检查导致结肠穿孔6例、外伤性结肠穿孔2例、炎性肠病导致穿孔3例、粪性肠穿孔2例、自发性结肠穿孔2例、结肠憩室2例;以急性腹膜炎主要表现的患者为17例、以局限性腹膜炎者7例、以腹部炎性包块者2例;有慢性便秘病史17例、合并糖尿病、动脉硬化合并脑梗塞、冠心病、慢性咳嗽等内科基础病13例;术前摄腹部平片示膈下游离气体12例、通过泛影葡胺灌肠造影确诊4例、手术确诊10例;降结肠穿孔9例、乙状结肠穿孔6例、横结肠穿孔2例、升结肠穿孔8例、盲肠穿孔1例;腹腔穿刺阳性11例。术前误诊8例,包括误诊为上消化道穿孔6例,阑尾穿孔2例。所有患者均行手术治疗,治愈21例,死亡5例。结论结肠穿孔有时术前确诊不易,只要可疑且有手术指征,应及早手术。

Objective To summarize the experience in diagnosis and treatment of peritoneal perforation of colon. Methods The clinical data of 26 patients with ruptured colon admitted to our hospital from January 2005 to October 2015 were analyzed retrospectively. Results Of 26 cases,colonic tumor perforation had nine cases,colon perforation after colonoscopy had 6 cases,traumatic perforation of colon had 2 cases,inflammatory bowel disease leads to perforation in 3 cases,fecal intestinal perforation spontaneous had 2 cases,colonic perforation had 2 cases,the perforated diverticulitis on colon was in 2cases. Seventeen cases presented with acute peritonitis,7 patients were mainly localized peritonitis,2cases mainly characterized by abdominal inflammatory mass. Medical history:chronic constipation in 17 cases,the basic disease of Medicine such as Diabetes mellitus,atherosclerosis,cerebral infarction,coronary heart disease,chronic cough in 20 cases. Preoperative abdominal radiography showed 12 cases of subdiaphragmatic free air,four cases were confirmed by enema and ten cases were confirmed by surgery,including perforation of descending colon in 9 cases,sigmoideum colon in 6 cases,transverse colon in 4 cases,ascending colon in 8,caecum in one. Eight cases were misdiagnosed before operation,perforation of upper digestive tract in six cases,appendiceal perforation in two cases. All patients underwent surgical treatment,21 cases were cured,5 cases died. Conclusion Perforation of colon is sometimes difficult to diagnose before surgery. As long as suspicious and correct surgical indications,the patients should undergo early surgical treatment.