粪块性结肠穿孔的诊断与治疗(附32例报告)

目的探讨粪块性结肠穿孔的诊断与治疗。方法对1990～2002年收治的粪块性结肠穿孔的32例临床资料进行回顾性分析。术前明确诊断17例,误诊为上消化道穿孔剖腹探查15例。全部病例均行急诊手术,病变结肠Ⅰ期切除吻合7例,穿孔段结肠切除、远端关闭、近端结肠造瘘15例,穿孔结肠拖出双腔造瘘6例,穿孔修补+乙状结肠造瘘4例。结果治愈24例,死亡8例,并发伤口感染6例。结论粪块性结肠穿孔的误诊率高(47.1%),预后差,改善本病治疗效果的关键在早诊断和早治疗。

Diagnosis and treatment of stercoral perforation of colon(A report of 32 cases)

Objective To investigate the diagnosis and treatment of steroral perforation of colon. Methods From 1990 to 2002,32 cases with stercoral perforation of colon were analyzed retrospectively. 17 Cases were diagnosed clearly before operation.15 Cases (17.1%)were misdiagnosed as perforation of upper digestive tract to laparotomy.All cases underwent an emergency operation.Primary resection and anastomosis of pathologic colon was performed in 7 cases.Colonectomy of perforated segment,distal closure and proximal colostomy was in 15 cases.Double luminal colostomy of the perforated colon was in 6 cases,Suture of perforation plus sigmoidostomy was in 4 cases. Results 24 cases were cured.8 cases died,and wound infection in 6 cases.Conclusion The stercoral perforation of colon has a high misdiagnosis rate and poor prognosis.It is the key point in the early diognosis and treatment for improving therapeutic effects.