结肠镜检查和治疗致肠穿孔的临床研究  

Clinical study of intestinal perforation caused by colonoscopic inspection and treatment

作　　者：徐勇军 彭琴 谭峥嵘[1] 魏亚元 龚江波[2] 徐继宗[2] XU Yongjun;PENG Qin;TAN Zhengrong;WEI Yayuan;GONG Jiangbo;XU Jizong(Department of Gastroenterology, the Second People's Hospital of Yichang, Institute of Gastroscopy Diagnosis and Treatment Research, China Three Gorges University, Yichang 443000, China;Department of Gastrointestinal Surgery, the Second People's Hospital of Yichang, Institute of Gastroscopy Diagnosis and Treatment Research, China Three Gorges University, Yichang 443000, China)

机构地区：[1]湖北省宜昌市第二人民医院三峡大学腔镜微创诊疗研究所消化科,宜昌市443000 [2]湖北省宜昌市第二人民医院三峡大学腔镜微创诊疗研究所胃肠外科,宜昌市443000

出　　处：《微创医学》2019年第2期150-152,共3页Journal of Minimally Invasive Medicine

摘　　要：目的探讨结肠镜检查和治疗导致肠穿孔的相关因素,分析其诊断与治疗策略。方法选取行电子结肠镜检查和治疗的患者共31 862例,回顾性分析发生肠穿孔患者的个人情况、穿孔因素、诊疗策略等临床资料。结果 31 862例患者中,结肠镜操作致肠穿孔16例,发生率为0.05%。其中检查导致穿孔9例,治疗导致穿孔7例。经治疗,所有患者均痊愈出院,无患者死亡,平均住院时间14.8 d。穿孔多发生于肠管转折处,其中直肠穿孔2例,直肠、乙状结肠交界处穿孔3例,乙状结肠穿孔8例,脾曲穿孔2例,肝曲穿孔1例。治疗方式:行腹腔镜下穿孔修补术7例,开腹穿孔修补术2例,穿孔修补+末端回肠造瘘6例,保守治疗1例。6例患者术后3个月至半年内再次住院行回肠造瘘还纳术。结论结肠镜检查和治疗导致穿孔易发生于乙状结肠,操作过程粗暴、局部肠壁薄弱及解剖结构异常是导致肠穿孔的三大重要因素。早期发现、积极手术是穿孔诊疗的基本原则,腹腔镜下穿孔修补为首选方案。Objective To investigate the related factors of intestinal perforation caused by colonoscopic inspection and treatment, and to analyze its diagnosis and treatment strategy. Methods A total of 31 862 patients who underwent electronic colonoscopic inspection and treatment were enrolled, and the clinical data of those with intestinal perforation were retrospectively analyzed, including personal conditions, perforation factors, and diagnosis and treatment strategy. Results Sixteen out of the 31 862 patients suffered from intestinal perforation due to colonoscopic operation, with the incidence rate of 0.05%, among which 9 cases suffered from perforation caused by colonoscopic inspection and 7 by colonoscopic treatment. All patients were cured and discharged after treatment, no cases died, with average hospital stay of 14.8 days. Perforation mainly occurred at the turning point of intestinal canal , including 2 cases in the rectum, 3 in the junction of rectum and sigmoid colon, 8 in the sigmoid colon, 2 in the splenic flexure, and 1 in the hepatic flexure. Treatment procedures included laparoscopic perforation repair(7 cases), open perforation repair(2 cases), perforation repair + terminal ileostomy (6 cases), and conservative treatment(1 case). Six patients were hospitalized again for ileostomy closure within 3 months to 6 months after operation. Conclusions Perforation caused by colonoscopic inspection and treatment is likely to occur in the sigmoid colon. Careless operation, local intestinal wall weakness, and anatomical structure abnormality are the three important factors leading to intestinal perforation. Early detection and active surgery are the primary principles for perforation diagnosis and treatment, and laparoscopic repair of perforation is the preferred option.

关 键 词：结肠镜 肠穿孔 诊疗策略 

分 类 号：R445.9[医药卫生—影像医学与核医学]