急性结肠穿孔22例临床分析  

Acute perforation of colon:clinical analysis of 22 patients

作　　者：陈智[1] 薛超荣[1] 林炳锵[1] 王荣林[1] 

机构地区：[1]福建医科大学附属协和医院急诊外科,福建福州350001

出　　处：《中国普通外科杂志》2011年第4期394-397,共4页China Journal of General Surgery

摘　　要：目的探讨急性结肠穿孔的发病原因、临床特点和治疗方法。方法回顾性分析收治的22例结肠穿孔患者的临床资料。结果穿孔原因:肿瘤性54.5%(12/22),外伤性27.3%(6/22),粪块性9.1%(2/22),憩室炎4.5%(1/22),肠套叠4.5%(1/22)。穿孔部位:盲肠31.8%(7/22),横结肠18.2%(4/22),降结肠9.1%(2/22),乙状结肠40.9%(9/22)。全部急诊手术,I期彻底性手术7例(31.8%),分期彻底性手术11例(50%),穿孔修补+永久性近端造瘘或永久性穿孔肠曲外置术4例。术后肺部感染6例(27.3%),合并胸腔积液2例(9.1%)、急性呼吸窘迫综合征2例(9.1%),予穿刺抽液、呼吸机辅助呼吸等治疗后好转;膈下脓肿2例(9.1%),经B超引导穿刺置管引流后好转;切口感染10例(45.5%),经换药愈合7例,全层裂开Ⅱ期缝合3例;肠瘘1例,改行造口术后好转。全组治愈18例(81.8%),2例(9.1%)因感染性休克、多器官功能衰竭于术后21 h,3 d死亡,自动出院2例(9.1%)。结论提高对结肠穿孔的认识,及时正确诊断,尽早手术,选择合理手术方式是提高其治疗效果的关键。Objective To explore the causes,clinical characteristics and treatment of acute perforation of colon.Methods The clinical data of 22 cases of acute colonic perforation from treated Feb 2007 to Feb 2010 Were retrospectively analysed.Results The etiology of perforation was cancer in 54.5%（12/22）,trauma in 27.3%（6/22）,fecal impaction in 9.1%（2/22）,diverticulitis in 4.5%（1/22）,and intussusception in 4.5%（1/22）.The location of perforation： cecum accounted for 31.8%（7/22）,transverse colon for 18.2%（4/22）,descending colons for 9.1%（2/22）,and sigmoid colon for 40.9%（9/22）.All cases underwent emergency surgery,with one-stage operation in 7cases（31.8%）,staged operation in 11 cases（50.0%）,and permenent colostomy in 4（18.2%）.After surgery,6 cases had pulmonary infection,of which 2 cases with pleural effusion were improved by paracentesis,2 cases with ARDS were improved by mechanical ventilation,and 2 cases with subphrenic abscess were improved by ultrasound-guided drainage.There were 10 cases of wound infection,of which 7 cases were cured by dressing change and 3 cases with abdominal incision dehiscence underwent resuture.One case with enterocutaneous fistula was treated by colostomy.Of the 20 cases,18 cases（81.8%） were cured,2cases（9.1%）died from septic shock and MOF,and 2 cases（9.1%） were discharged against-advice.Conclusions Improving the understanding of this disorder,early diagnosis,prompt and proper surgical procedure are the keys to improve the treatment effect of colonic perforation.

关 键 词：结肠穿孔 急性/外科学 急腹症 结肠造口术 

分 类 号：R656.9[医药卫生—外科学]