高龄患者乙状结肠壁肌层缺如致自发破裂的诊治探讨

Diagnosis and treatment of spontaneous rupture of sigmoid colon related to absence of muscle layer in elderly patients

目的:对乙状结肠自发性破裂病例的诊治进行探讨,明确其病因。方法:对我院2006-01—2019-01期间收治的10例乙状结肠自发性破裂的临床资料进行回顾性分析。结果:全部病例均行手术治疗,行乙状结肠部分切除加乙状结肠单腔造瘘术,术中见中下段乙状结肠单发穿孔,均不伴相应系膜发黑坏死,未合并肿瘤、息肉等其他病灶。病理提示穿孔处乙状结肠固有肌层缺如。结论:乙状结肠肌层缺如导致自发性破裂临床少见,病情凶险,且以高龄患者为主,手术为重要治疗方法,结肠造瘘术是主要术式。其病因为乙状结肠部分肠壁肌层缺如导致,目前尚缺乏有效预防手段。

Objective:To explore the diagnosis and treatment of spontaneous rupture of the sigmoid colon and clarify its etiology.Method:The clinical data of 10 cases of spontaneous rupture of the sigmoid colon from January 2006 to January 2019 in our hospital were retrospectively analyzed.Result:All cases underwent surgical treatment,partial sigmoid resection and sigmoid colostomy were performed.During the operation,the single-perforation of the sigmoid colon in the middle and lower segment was not accompanied by necrosis,and no other tumors and polyps were not found.Pathology indicated segmental absence of muscularis propria(SAMP)at perforation location.Conclusion:SAMP leaded to the spontaneous rupture of sigmoid colon were rare,dangerous for the elderly patients.Colostomy was the main procedure.The etiology of SAMP was not clear and there is still no effective prevention for SAMP.