自发性大肠破裂的诊断与治疗  

Diagnosis and treatment of spontaneous colorectal rupture.

作　　者：李全平[1] 狄长安[1] 

机构地区：[1]首都医科大学燕京医学院附属平谷医院普外科,北京101200

出　　处：《中国综合临床》2010年第9期969-971,共3页Clinical Medicine of China

摘　　要：目的分析自发性大肠破裂的病因、病理、诊断、治疗以及预后的相关因素。方法收集国内近十年报道的自发性大肠破裂病例155例，结合我院2002年以来诊治的自发性大肠破裂病例5例，进行临床相关因素分析。手术方式为破裂修补术5例、破裂修补外置5例、破裂修补＋近端结肠造瘘（单腔或双腔）43例、破裂肠管切除吻合＋近端肠管造瘘（单或双腔）61例、破裂肠管切除断端双腔造瘘6例、破裂肠管切除吻合5例、破裂肠管直接造瘘9例。余术式表述不详。结果治愈117例（73．1％，117／160），死亡43例（26．9％，43／160）。结论自发性大肠破裂多发生于老年患者，为少见病。确诊率低，易延误病情；同时腹腔污染致感染中毒性休克直接危及生命。及时诊断并手术治疗是提高治愈率的关键。Objective To retrospectively investigate the cause of spontaneous rupture of the large intestine, pathology, diagnosis, treatment and prognosis of the relevant factors. Methods The collection of domestic medical records of 155 cases of spontaneous rupture of the large intestine in last decades, combined with 5 cases collected in our hospital since 2002. All the cases underwent emergency surgery confirmed the preoperative diagnosis of straight, colon rupture in 25 cases . Surgical repair for rupture in 5 cases, rupture of an exterua] repair in 5 cases, rupture of the proximal colostomy repair combined with single or dual-chamber in 43 cases of ruptured bowel resection and anastomosis of the proximal intestine fistula combined with single or dual-chamber in 61 cases ruptured bowel resection stump of dual-chamber fistula in 6 cases,rupture of bowel resection and anastomosis in 5 cases,rupture of intestine directly fistula 9 cases. Surgical presentation in the remained cases were unknown. Results One hundred and seventeen patients cured, 43 cases died. Conclusions Most spontaneous colon rupture occurred in elderly patients,and is rare disease. The diagnosis rate is low and easy to delay in the treatment. Moreover, the intra- abdominal infections caused by pollution would lead to a direct life-threatening toxic shock. Therefore, prompt diagnosis and timely surgery is important to improve the cure rate.

关 键 词：大肠 自发破裂 外科手术 

分 类 号：R656.7[医药卫生—外科学]