急性非肿瘤性升结肠后壁穿孔诊治分析

目的探讨急性非肿瘤性升结肠后壁穿孔早期诊断和治疗方法。方法回顾性分析2007年7月-2014年4月收治的17例急性非肿瘤性升结肠后壁穿孔患者的临床资料,其中8例采用穿孔修补术＋腹腔引流术作为研究组,9例采用右半结肠切除术（或升结肠切除术）作为对照组,比较两组患者在围手术期的临床指标和生化指标。结果所有患者均治愈,研究组和对照组手术时间分别为（74.20±12.45）、（120.23±15.20）min,差异有统计学意义（t=-3.224,P〈0.001）;研究组和对照组术中失血量分别为（40.24±12.20）、（80.69±18.98）mL,差异有统计学意义（t=-4.114,P〈0.001）;研究组和对照组术后肛门排气时间分别为（75.62±6.56）、（84.54±7.82）h,差异有统计学意义（t=1.108,P=0.037）;研究组和对照组住院医疗费用分别为（1.82±0.57）、（2.65±0.83）万元,差异有统计学意义（t=-5.556,P〈0.001）;术后第3天研究组和对照组超敏C反应蛋白分别为（89.45±8.98）、（99.85±10.78）mg/L,差异有统计学意义（t=-3.004,P=0.029）;研究组和对照组术后住院时间分别为（9.80±3.16）、（9.81±3.20）d,差异无统计学意义（t=1.501,P=0.080）。研究组切口脂肪液化1例,对照组切口感染1例,均经门诊换药治愈。结论升结肠后壁穿孔早期腹部体征不明显,易误诊,早期诊断主要依靠临床症状、生命体征、血常规及CT等检查,其中CT检查提示腹膜后气体征具有确诊意义,应尽早行手术治疗,手术方式应优先选用穿孔修补术＋腹腔引流术,它具有手术简便,时间短,出血少,创伤反应较轻等优点。

Diagnosis and Treatment of Acute Non-tumor Perforation of the Back Wall of Ascending Colon

Objective To explore the early diagnosis and treatment of acute non-tumor perforation of the back wall of ascending colon. Methods We retrospectively analyzed the clinical data of 17 patients with acute non-tumor perforation of the back wall of ascending colon treated between July 2007 and April 2014 in our hospital. Among them, 8 patients who underwent perforation repair combined with abdominal cavity drainage were regarded as the experimental group, and the other 9 patients who underwent operation of right hemicolectomy（or ascending colon resection） were designated as the control group. Clinical indexes and biochemical indexes of both the two groups were compared and analyzed. Results All patients were cured. The operation time [（74.20 ± 12.45）,（120.23 ± 15.20） minutes; t=-3.224, P〈 0.001], the intraoperative blood loss [（40.24 ± 12.20）,（80.69 ± 18.98） mL; t=-4.114, P 〈0.001], the postoperative anal exhaust [（75.62 ± 6.56）,（84.54 ± 7.82） hours; t=1.108, P=0.037], the medical expenses [（18.2 ± 5.7） thousand yuan,（26.5 ± 8.3） thousand yuan; t=-5.556, P〈0.001], and the hypersensitive C-reaction protein on the third day after operation [（89.45 ± 8.98）,（99.85 ± 10.78） mg/L; t=-3.004, P=0.029] in the experimental group and the control group all had signifi cant differences. There was no signifi cant difference between the two groups in the hospital stay time [（9.80 ± 3.16）,（9.81 ± 3.20） days; t=1.501, P=0.080]. There was one case of incision infection in the experimental group and one case of fat liquefaction of incision in the control group, and both of them were cured after treatment. Conclusions The early abdominal sign of perforation of the back wall of ascending colon is not obvious, which can easily lead to misdiagnosis as acute appendicitis. Early diagnosis mainly depends on the clinical symptom, vital sign, blood routine examination and CT examination. Among them, CT fi ndings of gaseous sign behind peritoneum is a defi nite diagnosis, and