腹部CT在医源性结肠镜穿孔诊断中的应用价值

目的探讨腹部CT检查在医源性结肠镜穿孔(ICP)预防、诊断和治疗选择的重要性。方法回顾性分析2017年1月至2019年12月15例ICP患者的临床和CT影像资料。结果结肠镜术前CT检查8例,发现高危因素6例,鈷肠明显梗阻性扩张、乙状结肠迂曲冗长各2例乙状结肠多发憩室、结肠肠壁广泛轻度炎性水肿各1例。结肠镜术后CT检查15例,诊断腹腔内穿孔7例,腹膜后穿孔6例,累及腹膜腔内外穿孔2例。穿孔部位:升结肠4例、横结肠2例、降结肠2例、降结肠乙状结肠交界部1例、乙状结肠3例、直肠3例。内科保中治疗8例,外科手术治疗5例。钛夹夹闭1例,死亡1例。结论腹部CT检查有助于结肠镜术前发现高危因素,预防ICP的发生,结肠镜术后尽早确诊ICP,并为临床后续治疗方式的选择提供关键依据。

Objective To explore the importance of abdominal CT in the prevention,diagnosis and tratment of itrogenic colonoscopic perforation(ICP).Methods From January 2017 to December 2019,15 ICP patients'clinical and CT data were ollected and analyzed retrospectively.Results Before colonoscopy,8 cases were examined by CT and high risk factors were found in 6 cases.Among them,2 cases were obviously obstructive dilatation of colon,2 cases were redundant sigmoid colon,I case was multiple diverticulum of sigmoid colon,1 case was extensive mild inflamatory edema of colon intestinal wall.After colonoscopy,15 cases were examined by CT,7 cases were diagnosed as intraperitoneal perforation,6 cases were diagnosed as retroperitoneal perforation and 2 cases were diagnosed as retropericoneal and intrapericoneal perforation.The perforation sites were different,ascending colon in 4 cases,transverse colon in 2 cases,descending colon in 2 cases,descending and sigmoid junction in 1 case,sigmoid colon and rectum in 3 cases.8 cases were treated by conservative medical management,5 cases were treated by surgery,1 case were trated by titanium clamp,1 case died.Conclusion Abdominal CT examination is helpful to find the high risk factors of ICP and prevent ICP occurrence before performing the colonoscopy,make a definite diagnosis of ICP as early as possible afer endoscopic procedure,and provide key evidence for the development of treatment plan.