医源性结直肠损伤的原因分析及诊治

The cause analysis and diagnosis of iatrogenic colorectal injury

目的探讨医源性结直肠损伤的原因、诊断和治疗方法。方法回顾性分析2009年01月至2019年12月间在石河子市人民医院诊治的共29例医源性结直肠损伤病人的临床资料。结果损伤原因包括:结肠镜检查损伤(17/29或58.6%);手术损伤(10/29或34.5%),其中腹腔镜手术5例,滑疝3例,开腹肠梗阻2例;清洁灌肠(2/29或6.9%);行一期修复的病人(18/29或62.07%),行造口术的病人(10/29或34.48%),行术区敞开外引流术病人(1/29或3.45%)。结论造成医源性结直肠损伤的原因是多方面的,其重点在于预防,一旦发生,需要早发现、早诊断、个体化治疗,需要结合病人术中一般情况、手术的适应症以及手术医生的经验,选择有利于病人恢复的最佳方案。

Objective To explore the causes, diagnosis and treatment of iatrogenic colorectal injury. Methods Totally 29 patients with iatrogenic colorectal injury were retrospectively analyzed by reviewing their clinical data from January 2009 to December 2019 at people’s hospital of Shihezi. Results Causes of injury included as follows, the injury of colonoscopy was in 17 cases(58.6%);Surgical injuries were in 10 cases(34.5%), including 5 cases of laparoscopic surgery, 3 cases of hernia,and 2 cases of laparotomy intestinal obstruction. Cleaning enema were in 2 cases(6.9%). Primary repair was in 18 cases(62.07%). 10 patients underwent colostomy(34.48%), and 1 patients had external drainage of surgical incision(3.45%). Conclusion The causes of iatrogenic colorectal injury are multi-faceted and prevention is very important. Once it occurs, it needs early detection, early diagnosis, individualized treatment. It is necessary to select the best scheme to help patients recovery according to the general conditions of the patient during the operation, the indications of the operation and the experience of the surgeon.