8 例结肠腹膜外穿孔的临床诊治分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王进 , 董晓强 , 张志 , 毛德利 , 赵华 , 朱新国 ,  赵鑫

苏州大学附属第一医院普外科（江苏苏州 215006）;

Corresponding author：

赵鑫, Email: zhaox@suda.edu.cn

Keywords：

结肠腹膜外穿孔; 诊断; 治疗

DOI：

10.7507/1007-9424.201710045

Video：

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目的总结结肠腹膜外穿孔的诊断及治疗方法。方法回顾性分析 2010 年 1 月至 2017 年 1 月期间苏州大学附属第一医院收治的 8 例结肠腹膜外穿孔患者的临床资料。结果 8 例患者中，1 例为溃疡性结肠炎致穿孔，1 例为结肠憩室致穿孔，2 例为结肠癌致穿孔，4 例穿孔病因未明。1 例通过 CT 检查确诊，1 例通过 CT、MRI 及窦道造影检查确诊，1 例漏诊，2 例误诊为急性阑尾炎，3 例术前未明确诊断。所有患者均行手术治疗，其中 1 例行回肠造口术，术后 8 h 因重度感染性休克死亡，住院时间短于 24 h；4 例行结肠切除吻合术，住院时间为 9～53 d（中位数为 9.5 d）；2 例行结肠部分切除、近端肠管造瘘术，二期行造口关闭、肠吻合术，合计住院时间分别为 27 d 和 24 d；1 例行结肠穿孔修补、近端肠管造瘘术，住院时间为 7 d。7 例手术后存活患者均获访，随访时间 0.5～5.0 年，中位数为 3.7 年。随访期间，3 例死亡。结论结肠腹膜外穿孔的误诊率和漏诊率较高，对高度怀疑病例应结合病史及影像学检查，进行鉴别诊断；对病情危重、无法明确诊断者，应尽早行手术探查。

Citation： 王进, 董晓强, 张志, 毛德利, 赵华, 朱新国, 赵鑫. 8 例结肠腹膜外穿孔的临床诊治分析. 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, 孟庆彬, 李晓辉, 等. 外伤性结直肠穿孔的腹腔镜下结肠造瘘术. 中华普通外科杂志, 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.	郑建伟, 葵淑艳. 大肠穿孔 48 例临床特点及手术方式选择. 中华普通外科杂志, 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, 舒晔. 老年人自发性乙状结肠穿孔 9 例诊治体会. 中国普外基础与临床杂志, 2012, 19(9): 1001-1002.
14.	羊涛, 张嘉越, 冷津立, 等. 肠腔内外双套管负压引流在左半结肠穿孔一期修补术中的应用. 中华普通外科杂志, 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, 孟庆彬, 李晓辉, 等. 外伤性结直肠穿孔的腹腔镜下结肠造瘘术. 中华普通外科杂志, 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. 郑建伟, 葵淑艳. 大肠穿孔 48 例临床特点及手术方式选择. 中华普通外科杂志, 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, 舒晔. 老年人自发性乙状结肠穿孔 9 例诊治体会. 中国普外基础与临床杂志, 2012, 19(9): 1001-1002.
14. 羊涛, 张嘉越, 冷津立, 等. 肠腔内外双套管负压引流在左半结肠穿孔一期修补术中的应用. 中华普通外科杂志, 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 例结肠腹膜外穿孔的临床诊治分析

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