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。

Analysis and treatment of iatrogenic colonic perforation in 6 cases

ObjectiveTo explore the reasonsand early diagnosis and treatment methods of intestinal perforation which happened in colonoscopy and treatment. MethodsWe retrospectively analyzed the clinical data of 25 426 patients undergoing colonoscopy in 5 years of NingXia People′s hospital headquarters and branch offices and recorded the age，gender，clinical diagnosis，perforation site，perforation causes and treatments after intestinal perforation. ResultsThere were 6 cases of intestinal perforation, of which 5 had immediate perforation and 1 had delayed perforation. Of the 6 patients, 3 underwent colon polypus forceps. Endoscopic perforation was performed with titanium clips, and all the three patients were discharged after conservative treatment. In addition, 2 patients with colon tumor ulcers and 1 patients with ulcerative colitis were discharged after surgical treatment for performation. ConclusionColonic perforation is an uncommon complication during colonoscopy. Fully understanding the clinical data, fully estimation the indications and contraindications before operation of patients and gental operation could greatly reduced even avoided the incidence of such complications.