非创伤性结直肠穿孔病因分析及治疗体会

Etiological analysis and treatment of nontraumatic colorectal perforation

目的探讨非创伤性结直肠穿孔的病因、诊断和治疗经过。方法对2018年5月至2020年5月收治的6例非创伤性结直肠穿孔病人的临床资料进行回顾性分析。结果6例病人中,男性2例,女性4例,年龄33~78岁,平均年龄60.3岁。3例行手术治疗,其中肿瘤性结肠穿孔病人行左半结肠切除+横结肠造口术+腹腔引流术;自发性乙状结肠穿孔病人行剖腹探查+横结肠造口+腹腔引流+乙状结肠穿孔修补术,直肠穿孔病人行直肠穿孔挂线引流术。3例行保守治疗,予以禁食、肠外营养支持、抗感染、肝脓肿穿刺引流等对症治疗。6例病人均治愈出院。结论非外伤性结直肠穿孔病因复杂、病情变化快、并发症多,需密切关注病情变化,对于感染严重者,需及时行手术治疗,而病情较轻者可考虑保守治疗。

Objective To investigate the etiology,diagnosis and treatment of nontraumatic colorectal perforation.Methods The clinical data of 6 patients with nontraumatic colorectal perforation from May 2018 to May 2020 were retrospectively analyzed.Results Among the 6 patients,2 were male and 4 were female,aged 33-78 years;the average age was 60.3 years old.Three patients underwent surgical treatment,including left hemicolectomy+transverse colostomy+abdominal drainage for patients with tumor colon perforation;laparotomy+transverse colostomy+abdominal drainage+sigmoid colon perforation repair were performed for spontaneous sigmoid colon perforation patients,and rectal perforation patients were treated with rectal perforation thread drainage operation.3 cases were treated with conservative treatment,such as fasting,parenteral nutrition support,anti infection,liver abscess puncture drainage and other symptomatic treatment.All 6 patients were cured and discharged.Conclusion It is necessary to pay close attention to the changes of the disease.Surgical treatment should be carried out in time for patients with severe infection,while conservative treatment can be considered for patients with mild illness.