大肠穿孔临床特征的研究

目的：研究大肠穿孔病例的临床特点,更好的指导临床工作。方法：回顾性分析我院经手术或尸体解剖证实的大肠穿孔病例,分析患者的性别、年龄、症状、入院时血压、心率、腹部体征、血常规结果、就诊到手术时间、穿孔原因和住院期间转归等情况。结果：本组共32例,男性23例,女性9例;平均年龄52.7±18.7岁;其中7例死亡。全部病例中仅22例术前或尸检前诊断为消化道穿孔。本组患者1例三处穿孔,2例两处穿孔,其余为1个穿孔部位;穿孔分布以乙状结肠、直乙交界处较多。穿孔原因：大肠癌12例（37.5%）,其次是医源性损伤。28例（87.5%）患者腹痛是主要临床症状。体征分析出现腹肌紧张75%（24例）,出现腹部压痛90.6%（29例）,出现反跳痛65.6%（21例）,仅37.5%（12例）腹部X现平片出现游离气体;入院时平均体温、平均收缩压、舒、白细胞计数、中性粒细胞百分比及血小板计数等存活组和死亡组无显著差异。死亡病例与存活病例相比较心率快,舒张压低（P〈0.05）;24h内得到手术探查者存活率高（F=0.006）。结论：大肠穿孔患者诊断正确率低,死亡率高。造成大肠穿孔原因首位是大肠癌,其次是医源性损伤;大肠穿孔以单个穿孔多见,大肠穿孔临床表现不典型,腹膜炎的体征往往缺如,腹腔游离气体出现率低。早期手术干预可有效降低死亡率。

Clinical Features of Patients with Large Intestine Perforation

Objective： Investigating clinical characteristic of patients with colon perforation to get experience of diagnosis and treatment. Method： 32 patients with large intestine perforation were included into the retrospective study in our Hospital. Diagnosis with colon perforation depended on result of surgery or autopsy.Patients＇ data including sex,age,symptom,vital sign on admission,abdominal sign,routine analysis of blood,duration from visiting doctor to operating,occasion of perforating and outcome was collected and analyzed. Result： Of 32 patients,23 were male and 9 were female,with an average age of 52.7±18.7 years and7 died in hospital. Most patients suffered with 1 lesion,except 1 case with 3 lesions and 2 cases with 2 lesions. Sigmoid or juncture of rectum and sigmoid was major sites of perforation; 12（ 37.5%） patients were caused by tumor and 7 cases（ 21.9%） were induced by iatrogenic injury. 22 cases（ 68.8%） were accurately diagnosis.30（ 93.8 %） patients complained with abdominal pain. 24（ 75%） had abdominal sign with guarding,29（ 90.6%） with abdominal tenderness and 21（ 65.6%） with rebound tenderness. Only 12 patients（37.5%） showed free air in X-ray film. Between survival and non-survival groups,diastolic pressure,heart rate and duration time waiting operation were significantly different; multiple logistic regression equation showed only duration time waiting operation affect mortality. Conclusion： Patients with colon perforation had a high mortality and low accuracy of diagnosis. The major sites of lesion were sigmoid and most patients caused by tumor. The major clinical manifestation is abdominal pain and free air in X-ray film of peritoneal cavity is uncommon. Early operation seems decrease mortality.