诊断性结肠镜并发肠穿孔11例分析

Analysis of 11 cases of colonic perforation during diagnostic colonoscopy

目的总结诊断性结肠镜并发肠穿孔内镜治疗的经验。方法回顾性分析11例诊断性结肠镜并发肠穿孔患者的临床资料,统计内镜下金属夹闭成功闭合情况,分析其穿孔大小、使用金属夹情况、常规干预方法及住院时间。结果6例经内镜下金属夹成功治疗,穿孔大小为0.4~1.0 cm,均好转;5例经内治疗失败转外科手术,穿孔大小为2~6 cm,4例好转,1例死亡。内镜成功患者中位穿孔大小为0.8 cm,小于追加手术患者的4.00 cm,差异有统计学意义(P<0.05)。内镜成功患者中位住院时间为13.50 d,短于追加手术患者的29.00 d,差异有统计学意义(P<0.05)。结论肠穿孔≤1 cm可通过内镜下金属夹治疗成功,外科手术是内镜治疗失败的重要补救措施,肠穿孔≥2 cm可能需要追加手术。

Objective To summarize the experience of endoscopic treatment of colonic perforation during diagnostic colonoscopy.Methods The clinical data of 11 patients with colonic perforation during diagnostic colonoscopy in our hospital were retrospectively analyzed.The successful closure of endoscopic metal clips was counted,and the perforation size,use of metal clips,conventional intervention methods and length of hospital stay were analyzed.Results 6 cases were successfully treated with endoscopic metal clips,with perforation sizes of 0.4-1.0 cm,and all improved;5 cases were converted to surgery after failed endoscopic treatment,with perforation sizes of 2-6 cm;4 cases improved,and 1 case died.The median size of perforation in successful endoscopic patients was 0.8 cm,which was smaller than 4.00 cm in patients with additional surgery,and the difference was statistically significant(P<0.05).The median length of hospital stay was 13.50 d for successful endoscopic patients,which was shorter than that of 29.00 d for additional surgery patients,and the difference was statistically significant(P<0.05).Conclusion Colonic perforations≤1 cm can be successfully treated by endoscopic metal clips,and surgery is an important remedy for failed endoscopic treatment;perforations≥2 cm may require additional surgery.