老年人钡剂性肠梗阻致肠穿孔1例并文献复习

目的探讨老年人钡剂性肠梗阻的临床特点及手术治疗的重要性。方法报道本院1例钡剂性肠梗阻发生肠穿孔的病例并复习14例手术治疗的文献病例。结果本文病例6例手术证实钡剂性肠梗阻合并肠穿孔,7例行肠段切除术和肠肠吻合术,2例单纯性结肠切开取石术,4例死亡（占26．7％）。结论钡剂性肠梗阻保守治疗后无明显好转者,应积极手术,避免导致肠壁坏死穿孔。     

结肠镜检查及治疗并发穿孔分析

目的探讨结肠镜诊治过程中出现急性消化道穿孔的原因、诊断及预防和处理方法。方法回顾性分析2005年-2011年8例结肠镜检查致消化道穿孔病例资料。结果结肠镜并发结肠穿孔8例,诊断性肠穿孔4例,其中1例为无痛肠镜检查后穿孔,治疗性穿孔4例。当前,并发结肠穿孔主要为治疗性肠穿孔,穿孔主要位于乙状结肠及其移行区。结论结肠镜诊疗中并发肠穿孔的比例并不高,治疗取决于患者的临床状况及有无基础的肠道疾病,肠穿孔并发感染或有肠道基础疾病时,行手术治疗(开腹或腹腔镜);穿孔较小或患者一般状况好时可行内镜下治疗(金属夹)及保守治疗(禁食水加抗生素)。     

43例腹腔结核并发肠穿孔患者的外科治疗效果分析

目的 分析外科治疗腹腔结核致肠穿孔患者的临床情况。方法 收集河北省胸科医院2008—2016年收治的43例经手术病理确诊的腹腔结核伴肠穿孔患者,所有患者经胸部X线摄影或CT扫描检查均为可疑肺结核。描述性总结分析其术前临床表现、实验室检测及各项检查、术中探查及手术方式、术后治疗及并发症、治疗结果、随访结果等临床资料。结果 43例患者术后病理证实均存在腹腔结核,其中32例非急诊患者临床诊断明确者18例,11例急诊患者术前均未明确诊断;术中探查均存在肠穿孔,其中术前考虑单纯肠梗阻3例、肠梗阻伴肠穿孔30例(8例急诊和22例非急诊患者术前经诊断性穿刺诊断肠穿孔)、单纯肠穿孔10例。40例(93.0%)因病变范围广泛、感染严重行Ⅰ期肠切除+造瘘术,其中12例切口感染患者经切口换药、引流后治愈;8例发生肠瘘患者除2例(保守治疗、二次手术各1例,年龄均>65岁)因多脏器功能衰竭死亡外,余6例经治疗后预后良好;2例发生肠梗阻患者1例行二次手术、1例保守治疗后治愈;余18例患者造瘘术后恢复良好。2例(回盲部肿物伴穿孔1例,腹腔感染较轻1例)行回盲部切除+回结肠吻合术;1例因近回盲部出现回肠局部单一穿孔,且同时并发腹腔淋巴结结核、局部淋巴结节和穿孔部位回肠粘连,但腹腔感染较轻的患者行回肠部分切除+肠吻合术,术后无严重并发症。抗结核治疗12个月后均治愈停药。37例患者停药后随访18~24个月,4例患者失访,随访期内16例患者有间断轻微腹痛症状,其他患者一般情况均良好。结论 腹腔结核伴肠穿孔是严重的消化道结核并发症,规范的抗结核药物治疗是基础,而外科手术是有效治疗的首选方式,治疗效果良好。     

老年非外伤性结肠穿孔52例临床分析

回顾性分析52例老年非外伤性结肠穿孔患者的临床资料。本组52例患者多以急腹症就诊，无特异性临床表现，全部行手术治疗。术后痊愈45例，死亡7例。认为癌性穿孔是老年非外伤性结肠穿孔的主要原因，术前易误诊，应尽早剖腹探查；充分引流，积极加强对围手术期的监护和综合治疗可降低病死率；早期诊断和安全有效的综合治疗是防止并发症发生及救治成功的关键。     

医源性结肠穿孔原因分析及处理措施

目的探讨结肠镜检查及治疗时发生肠穿孔的原因及对其早期诊断和治疗的方法。 方法回顾性分析2013年1月至2017年12月经宁夏人民医院总院和分院行结肠镜检查或治疗的25 426例患者的临床资料,记录发生肠穿孔患者的年龄、性别、临床诊断、穿孔部位、穿孔原因及穿孔后的治疗方法。 结果共有6例发生肠穿孔,其中,5例为即刻穿孔、1例为迟发性穿孔。6例患者中,3例为结肠息肉钳除术患者,内镜下用钛夹封闭穿孔,经保守治疗后出院;另外2例结肠肿瘤溃疡、1例溃疡性结肠炎患者经外科治疗后好转出院。 结论结肠穿孔是结肠镜诊疗时并不常见的并发症;术前应充分了解患者的临床资料,严格掌握适应证及禁忌证,操作时动作轻柔,可最大程度地减少或避免此类并发症的发生。     

结肠途径治疗机治疗粪石性肠梗阻155例的临床研究

目的观察结肠途径治疗机治疗粪石性肠梗阻的临床疗效。方法将符合诊断标准的305例粪石性肠梗阻患者随机分为保守治疗组(75例)、手术治疗组(75例)与结肠途径治疗机组(155例)。三组均采用禁食、禁水、持续胃肠道减压、纠正水和电解质紊乱及酸碱失衡等对症治疗,手术治疗组在此基础上采用外科手术治疗,结肠途径治疗机组在此基础上采用结肠途径治疗机治疗。三组均治疗6d(1个疗程),治疗1个疗程后观察疗效。结果治愈率保守治疗组为53.33%,手术治疗组为100.00%,结肠途径治疗机组为96.77%。手术治疗组和结肠途径治疗机组的治愈率高于保守治疗组(P0.05)。手术治疗组与结肠途径治疗机组相比治愈率差异无统计学意义(P0.05)。并发症发生率保守治疗组为3.23%,手术治疗组为29.33%,结肠途径治疗机组为6.45%。手术治疗组高于结肠途径治疗机组和保守治疗组(P0.05),结肠途径治疗机组与保守治疗组相比较差异无统计学意义(P0.05)。结论结肠途径治疗机治疗粪石肠梗阻疗效与外科手术治疗的疗效相当,但结肠途径治疗机组治疗后副作用低,住院时间短。     

重症胰腺炎的结肠并发症

重症胰腺炎累及结肠虽不多见,但却是致命的。其病变包括结肠局部麻痹、胰腺炎性肿块压迫结肠引起梗阻、胰腺炎后结肠狭窄、结肠瘘,以及结肠坏死。本文报道作者处理10例重症胰腺炎并发肠穿孔及坏死的经验。10例结肠病变中7例是在胰腺手术或剖腹探查中获得诊断,另3例在术后4～19天发现,该3例中的1例出现持续腹腔脓毒症,另2例引流液中出现粪汁。病变累及横结肠3例;脾曲结肠4例;同时累及脾曲和降结肠1例;升结肠1例;接近全结肠1例。全部病人接受了病变结肠切除及近端结肠或回肠造瘘术。4例切除的结肠标本显示为缺血性损害,其程度从早期粘膜坏死、上皮细胞坏死脱落、肠壁固有层水肿及充血,直至严重的全层肠壁梗塞坏死。本组患者的结肠坏死病变很可能是从肠壁内侧向外侧发展的。10例中的另6例结肠未见缺血损害,其中4例有结肠穿孔,该4例中的2例分别为先天性或后天性憩室穿孔,标本提示继发于急性胰腺炎的肠壁外炎症导致穿孔;6例中另2例接近正常的结肠粘膜突然变成穿孔、边缘充血的肉芽     

自发性结肠穿孔5例

目的通过回顾性分析以揭示影响本组病例愈后的主要因素．方法近年来我院共收住自发性结肠穿孔患者5例，男3例，女2例；年龄51岁～81岁，平均72．2岁，发病前均体健；临床表现为突发剧烈腹痛，明显腹膜炎体征，腹穿抽得脓性粪臭腹水；术前误诊为上消化道穿孔3例，阑尾炎及胰腺炎各1例；均为乙状结肠穿孔，行肠穿孔修补外置术3例，肠穿孔修补加近端结肠造瘘2例．结果发病8h内手术3例，2例出现休克症象，1例术后并发腹腔脓肿，肺部感染，均治愈；发病14h，24h手术各1例，术前均出现难以纠正的低血压，术中术后血压极不稳定，分别于术后1d，4d死于多器官功能衰竭．结论本病愈后差，死亡率高，早期诊断早期手术是降低死亡率的关键．     

经肛型肠梗阻减压导管治疗急性左半结肠恶性梗阻的价值

结直肠癌的发病率逐年上升,目前仍有部分患者以完全性或不完全性肠梗阻为首发症状就诊。由于大肠的解剖特点,一旦发生肠梗阻,即形成一个闭合性肠袢,易导致坏死、穿孔,故以往常行急诊Hartman手术,即姑息性切除肿瘤,近端结肠造瘘,远端结肠关闭,之后再择期关闭造瘘口。此种方法患者须行二次手术,病程长,痛苦大,费用高。     

结肠镜诊疗中并发肠穿孔原因分析

目的 分析结肠镜诊治过程中发生肠穿孔的原因.为避免肠道穿孔提供参考.方法 回顾性分析:1995年1月到2007年6月行结肠镜检查19 814人次,治疗3 226人次发生肠穿孔的病例资料.结果 发生肠穿孑L 8例,男5例,女3例, 年龄48-80岁.诊断性肠镜检查肠穿孔4例,穿孔率O.02%.位于乙状结肠及其移行部,是插镜过程中镜身或镜头对肠壁直接作用力过大所致;治疗性肠穿孔4例,穿孔率0.12%.发生于无蒂或亚蒂息肉电凝切除时.6例患者行肠修补术或肠造瘘加修补术,l例经保守治疗痊愈,1例伴有慢性肾功能不全者在穿孔后出现感染性休克死亡.结论 结肠镜诊疗中并发肠穿孔的比例并不高,经验不足和操作粗暴是造成肠穿孔的重要原因.对无蒂或亚蒂息肉进行电凝切除时尤其要小心.术后应严密观察病情变化,发生穿孔后及时处理是必要的.     

特发性乙状结肠穿孔24例老年患者临床分析

目的 探讨老年人特发性乙状结肠穿孔的临床特征。方法 回顾性分析老年特发性乙状结肠穿孔患者24例的发病诱因、临床特征和治疗效果。结果 24例平均年龄68．7岁，均突然发病，平均病程5．2h。19例有习惯性便秘。表现为全腹膜炎21例(87．5％)，局限性腹膜炎3例，术前仅确诊4例，误诊20例(83．3％)，其中误诊为急性阑尾炎穿孔9例，上消化道穿孔7例，绞窄性肠梗阻4例。24例均行手术治疗，20例痊愈出院；死亡4例(16．7％)，3例死于感染中毒性休克，1例死于并发肺部感染。结论 认真询问病史，加强认识，对本病诊断极为重要；早期手术是治疗本病的根本措施，正确处理穿孔、彻底清洗腹腔、清洁肠道及术后充分引流是治疗本病的关键。     

Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon

PURPOSE: Stercoral perforation of the colon is reported to be a rare disease with poor prognosis. The aim of this study was to determine the frequency of stercoral perforation of the colon, to define diagnostic criteria for stercoral perforation of the colon, and to analyze the patient outcome in a university hospital gastrointestinal surgery unit. METHODS: From November 1993 until November 1998 all surgically treated patients with a colorectal disease were prospectively recorded in a computerized database. Diagnosis of stercoral perforation of the colon was made if 1) the colonic perforation was round or ovoid, exceeded 1 cm in diameter, and lay antimesenteric; 2) fecalomas were present within the colon, protruding through the perforation site or lying within the abdominal cavity; and 3) pressure necrosis or ulcer and chronic inflammatory reaction around the perforation site were present microscopically. Any additional colon pathology led to exclusion from the diagnosis of stercoral perforation of the colon. Using the same criteria, 81 cases in the literature were found to qualify and were further analyzed. RESULTS: In a five-year period 1,295 patients underwent colorectal interventions through laparotomy. A total of 566 (44 percent) cases were emergencies, 220 (17 percent) of these caused by colonic perforation. Seven patients had stercoral perforation of the colon. The incidence of stercoral perforation of the colon was 0.5 percent of all surgical colorectal procedures through laparotomy, 1.2 percent of all emergency colorectal procedures, and 3.2 percent of all colonic perforations. The mean age of the patients was 59 (median, 64; range, 22–85) years. All perforations were situated in the left hemicolon or upper rectum. The round or ovoid perforation had a mean diameter of 3.6 cm. Fecalomas were present in all patients and protruded from the perforation site or were found within the free abdominal cavity in three of them. Generalized stercoral peritonitis was a constant finding. Using a colonic resection without immediate restoration of continuity, an extensive intraoperative lavage, and antibiotics, there was no in-hospital mortality. Analysis of the reports in the literature revealed additionally that 28 percent of patients with stercoral perforation of the colon have multiple stercoral ulcers in the colon and that substantial mortality is encountered if only minor surgical procedures of treatment are used. CONCLUSIONS: The incidence of stercoral perforation of the colon seemed to have been underestimated. The reason for this might be the lack of defined diagnostic criteria for this disease. Low mortality is obtained by early surgical eradication of the affected part of the colon, including all stercoral ulcers, and by aggressive therapy for peritonitis.Presented in part at the meeting of the Swiss Society of Surgery, Lugano, Switzerland, June 9 to 12, 1999.     

Stercoral ulceration and perforation of the sclerodermatous colon: Report of two cases and review of the literature

Summary The pathologic changes which attend sclerodermatous involvement of the colon suggest that stercoral ulceration associated with spontaneous perforation may be a common accompaniment. However, this is a triad rarely encountered. The authors describe two such cases and discuss the diagnosis, pathologic anatomy and management of patients with stercoral ulceration and bowel perforation, particularly when associated with scleroderma.     

Management and prevention of fecal impaction

Fecal impactions occur in both sexes at any age but are particularly concentrated in children, in the institutionalized or impaired elderly, and in patients with certain psychiatric disorders or medical conditions that predispose to obstipation. The clinical consequences may be disabling and occasionally life threatening. Clinical manifestations include fecal incontinence, abdominal distention and pain, anorexia, weight loss, intestinal obstruction, and stercoral ulceration with bleeding or colonic perforation. Diagnosis begins with recognition of possible fecal impaction and confirmation by digital examination or abdominal radiography. Management consists of disimpaction, colon evacuation, and a maintenance bowel program to prevent recurrent impactions.     

Use of gastrointestinal contrast studies in obstruction of the small and large bowel

Gastrointestinal contrast studies were performed in 96 (27 percent) of 342 patients with small-bowel obstruction including 57 upper gastrointestinal and 39 barium-enema examinations. In 34 patients, upper gastrointestinal examination disclosed either obstruction or failure of contrast to reach the cecum in 24 hours; all 34 patients required surgery. The remaining 23 patients who had upper gastrointestinal studies recovered with tube decompression. Barium enema demonstrated obstruction in 13 (33 percent) of 39 cases of suspected small-bowel obstruction and localized obstruction in the colon rather than small bowel in 9 of 13 cases. Barium enema was 100 percent predictive of surgery when obstruction was shown, but was not helpful in predicting surgery when obstruction was not demonstrated. Surgery was required in 42 percent of patients whose barium enema did not show obstruction. Barium enema also was performed in 19 of 23 patients with large-bowel obstruction and showed the level of obstruction in all cases. All patients with largebowel obstruction required surgery except for three who recovered after barium-enema reduction of intussusception or volvulus. Barium upper gastrointestinal examination is recommended in small-bowel obstruction when plain films are nondiagnostic, and in selected cases of small-bowel obstruction that do not resolve with a short trial of tube decompression. Barium enema is not recommended in suspected small-bowel obstruction but should be performed in all cases of largebowel obstruction, except when perforation is a possibility or when the cecum measures 10 cm or larger in diameter.     

Sigmoid perforation in patients with chronic constipation

From 1976 to 1982, seven cases of free perforation of the sigmoid colon were treated at the Soroka University Hospital. None of the patients suffered any known underlying disease of the affected bowel such as malignancy, diverticulosis, stercoral ulcer, colitis, or trauma. The only feature common to all seven patients was a long history of chronic constipation. All patients were treated surgically with no mortality and with minimal morbidity. We believe that severe untreated chronic constipation may, on rare occasions, cause free perforation of the sigmoid colon.     

Management of patients with stercoral perforation of the sigmoid colon： Report of five cases

To our knowledge,stercoral perforation of the colonis rarely seen with fewer than 90 cases reported inthe literature till date.We explored the principles ofmanagement to prevent impending mortality in fivepatients with this condition.Five patients,two malesand three females,whose median age was 64 years,had sustained stercoral perforation of the sigmoid colon.Chronic constipation was the common symptom amongthese patients.Three patients underwent a Hartmann'sprocedure and another two were treated with segmentalcolectomy with anastomosis and diverting colostomy.There was one surgical mortality and the other patientshad an uneventful hospital stay.Timely intervention toprevent and/or treat any associated sepsis along withextensive peritoneal lavage and surgical intervention toremove diseased colonic tissue at the primary stercoralulceration site coupled with aggressive therapy for peri-tonitis are key treatment modalities in salvaging patientspresenting with stercoral perforation of the colon.     

结肠镜检查前肠道准备致肠梗阻2例分析

2例老年患者行结肠镜检查,常规使用复方聚乙二醇电解质散（恒康正清）肠道准备,患者肠道准备差,嘱患者口服20%甘露醇250 mL,5%葡萄糖盐水1 000 mL,再次肠道准备,2例患者皆出现肠梗阻,后病理证实肠腔狭窄为结肠癌所致。恒康正清清肠后肠道准备差提示肠道不完全梗阻可能,老年人肠道肿瘤可能性大。继续使用20%甘露醇250 mL及5%葡萄糖盐水1 000 mL清肠可能增加狭窄肠管梗阻风险。     

手术治疗老年人急性肠梗阻183例临床分析

目的 总结老年人急性肠梗阻的临床特点。方法 回顾性分析我院1992年10月至2001年10月经手术治疗183例老年急性肠梗阻患者的临床资料。结果 183例经手术治疗老年人急性肠梗阻中，嵌顿性疝占首位(43．2％)。本组同期收治老年人结肠癌中，40．6％(43／106)以急性肠梗阻为人院始发原因。本组19例左半结肠癌中，手术切除17例，其中12例行Ⅰ期吻合，2例并发吻合口瘘(16．7％)。围手术期病死率3．3％(6／183)，皆因手术过晚所致。结论 积极有效手术干预，可使大多数老年急性肠梗阻患者得到治愈或不同程度缓解。     

Chronic constipations in elderly people]

Chronic constipations in elderly people proved to be an important medical and social problem due to their high prevalence and serious complications caused by the very disease and administration of stimulating laxatives. They include as follows: anorectic incontinence, large intestine obstruction, stercoral ulcers, laxative dependence and bowels toxic affection (Cathartic colon). Morphological and physiological prerequisites of chronic constipation and anorectic incontinence occurrence are examined in this review. Drugs and tactics for monitoring constipations depending on their severity, dominance of transit and evacuation disturbances, occurrence of anorectic incontinence are described. Characteristics of laxatives and intestinal motility regulators, range of side effects as well as experience of their application in elderly patients with functional constipations and irritable bowel syndrome are presented.