8 例結腸腹膜外穿孔的臨床診治分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王進 , 董曉強 , 張志 , 毛德利 , 趙華 , 朱新國 ,  趙鑫

蘇州大學附屬第一醫院普外科（江蘇蘇州 215006）;

Corresponding?author：

趙鑫, Email: zhaox@suda.edu.cn

Keywords：

結腸腹膜外穿孔; 診斷; 治療

DOI：

10.7507/1007-9424.201710045

Video：

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目的總結結腸腹膜外穿孔的診斷及治療方法。方法回顧性分析 2010 年 1 月至 2017 年 1 月期間蘇州大學附屬第一醫院收治的 8 例結腸腹膜外穿孔患者的臨床資料。結果 8 例患者中，1 例為潰瘍性結腸炎致穿孔，1 例為結腸憩室致穿孔，2 例為結腸癌致穿孔，4 例穿孔病因未明。1 例通過 CT 檢查確診，1 例通過 CT、MRI 及竇道造影檢查確診，1 例漏診，2 例誤診為急性闌尾炎，3 例術前未明確診斷。所有患者均行手術治療，其中 1 例行回腸造口術，術后 8 h 因重度感染性休克死亡，住院時間短于 24 h；4 例行結腸切除吻合術，住院時間為 9～53 d（中位數為 9.5 d）；2 例行結腸部分切除、近端腸管造瘺術，二期行造口關閉、腸吻合術，合計住院時間分別為 27 d 和 24 d；1 例行結腸穿孔修補、近端腸管造瘺術，住院時間為 7 d。7 例手術后存活患者均獲訪，隨訪時間 0.5～5.0 年，中位數為 3.7 年。隨訪期間，3 例死亡。結論結腸腹膜外穿孔的誤診率和漏診率較高，對高度懷疑病例應結合病史及影像學檢查，進行鑒別診斷；對病情危重、無法明確診斷者，應盡早行手術探查。

Citation： 王進, 董曉強, 張志, 毛德利, 趙華, 朱新國, 趙鑫. 8 例結腸腹膜外穿孔的臨床診治分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(4): 479-482. doi: 10.7507/1007-9424.201710045 Copy

1.	Dehal A, Tessier DJ. Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy. JSLS, 2014, 18(1): 136-141.
2.	Tiwari A, Sharma H, Qamar K, et al. Recognition of extraperitoneal colonic perforation following colonoscopy: a review of the literature. Case Rep Gastroenterol, 2017, 11(1): 256-264.
3.	Brown CV. Small bowel and colon perforation. Surg Clin North Am, 2014, 94(2): 471-475.
4.	Sharma G, Jangid DK, Yadav SS, et al. Retro-renal colon: role in percutaneous access. Urolithiasis, 2015, 43(2): 171-175.
5.	Wang W, Jovel J, Halloran B, et al. Metagenomic analysis of microbiome in colon tissue from subjects with inflammatory bowel diseases reveals interplay of viruses and bacteria. Inflamm Bowel Dis, 2015, 21(6): 1419-1427.
6.	瞿紫微, 孟慶彬, 李曉輝, 等. 外傷性結直腸穿孔的腹腔鏡下結腸造瘺術. 中華普通外科雜志, 2014, 29(2): 140-141.
7.	Shin YJ, Kim YH, Lee KH, et al. CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy. Clin Radiol, 2016, 71(10): 1030-1036.
8.	Maddu KK, Mittal P, Arepalli CD, et al. Colorectal emergencies and related complications: a comprehensive imaging review—noninfectious and noninflammatory emergencies of colon. AJR Am J Roentgenol, 2014, 203(6): 1217-1229.
9.	鄭建偉, 葵淑艷. 大腸穿孔 48 例臨床特點及手術方式選擇. 中華普通外科雜志, 2015, 30(10): 823-824.
10.	Tan KK, Hong CC, Zhang J, et al. Predictors of outcome following surgery in colonic perforation: an institution’s experience over 6 years. J Gastrointest Surg, 2011, 15(2): 277-284.
11.	Onishi H, Sumiyoshi K, Terasaka R, et al. Surgical treatment to aid patients with colorectal perforation. In Vivo, 2014, 28(5): 997-1000.
12.	Akbulut F, Tok A, Penbegul N, et al. Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment. Urolithiasis, 2015, 43(6): 521-526.
13.	何雨, 魏耿耿, 舒曄. 老年人自發性乙狀結腸穿孔 9 例診治體會. 中國普外基礎與臨床雜志, 2012, 19(9): 1001-1002.
14.	羊濤, 張嘉越, 冷津立, 等. 腸腔內外雙套管負壓引流在左半結腸穿孔一期修補術中的應用. 中華普通外科雜志, 2014, 29(11): 872-873.
15.	De Brabandere K, De Waele B, Delvaux G. Colonic ischemia and perforation associated with enteral feeding through an ileal tube. Nutr Clin Pract, 2010, 25(3): 301-303.

1. Dehal A, Tessier DJ. Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy. JSLS, 2014, 18(1): 136-141.
2. Tiwari A, Sharma H, Qamar K, et al. Recognition of extraperitoneal colonic perforation following colonoscopy: a review of the literature. Case Rep Gastroenterol, 2017, 11(1): 256-264.
3. Brown CV. Small bowel and colon perforation. Surg Clin North Am, 2014, 94(2): 471-475.
4. Sharma G, Jangid DK, Yadav SS, et al. Retro-renal colon: role in percutaneous access. Urolithiasis, 2015, 43(2): 171-175.
5. Wang W, Jovel J, Halloran B, et al. Metagenomic analysis of microbiome in colon tissue from subjects with inflammatory bowel diseases reveals interplay of viruses and bacteria. Inflamm Bowel Dis, 2015, 21(6): 1419-1427.
6. 瞿紫微, 孟慶彬, 李曉輝, 等. 外傷性結直腸穿孔的腹腔鏡下結腸造瘺術. 中華普通外科雜志, 2014, 29(2): 140-141.
7. Shin YJ, Kim YH, Lee KH, et al. CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy. Clin Radiol, 2016, 71(10): 1030-1036.
8. Maddu KK, Mittal P, Arepalli CD, et al. Colorectal emergencies and related complications: a comprehensive imaging review—noninfectious and noninflammatory emergencies of colon. AJR Am J Roentgenol, 2014, 203(6): 1217-1229.
9. 鄭建偉, 葵淑艷. 大腸穿孔 48 例臨床特點及手術方式選擇. 中華普通外科雜志, 2015, 30(10): 823-824.
10. Tan KK, Hong CC, Zhang J, et al. Predictors of outcome following surgery in colonic perforation: an institution’s experience over 6 years. J Gastrointest Surg, 2011, 15(2): 277-284.
11. Onishi H, Sumiyoshi K, Terasaka R, et al. Surgical treatment to aid patients with colorectal perforation. In Vivo, 2014, 28(5): 997-1000.
12. Akbulut F, Tok A, Penbegul N, et al. Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment. Urolithiasis, 2015, 43(6): 521-526.
13. 何雨, 魏耿耿, 舒曄. 老年人自發性乙狀結腸穿孔 9 例診治體會. 中國普外基礎與臨床雜志, 2012, 19(9): 1001-1002.
14. 羊濤, 張嘉越, 冷津立, 等. 腸腔內外雙套管負壓引流在左半結腸穿孔一期修補術中的應用. 中華普通外科雜志, 2014, 29(11): 872-873.
15. De Brabandere K, De Waele B, Delvaux G. Colonic ischemia and perforation associated with enteral feeding through an ileal tube. Nutr Clin Pract, 2010, 25(3): 301-303.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

8 例結腸腹膜外穿孔的臨床診治分析

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