纤维结肠镜在结肠梗阻的病因诊断和治疗中的价值

目的:探讨纤维结肠镜在结肠梗阻时的应用价值,旨在为临床合理选择提供参考。方法:回顾性分析经钡灌肠检查诊断为结肠梗阻而住院的患者56例,其中结肠癌46例手术治疗,结肠扭转5例中1例手术,4例肠镜复位,粪便嵌塞4例保守治疗,空肠粘连性梗阻1例手术。结果:死亡3例(7.14%),1例盲肠癌伴梗阻,2例乙状结肠癌伴梗阻,均死于术后24h内,死亡原因为多器官功能衰竭。无吻合口漏发生,切口感染3例,切口裂开1例,造口出血2例,造口狭窄4例,肺部感染6例。平均随访时间20个月。发现大肠息肉8例14枚,全部高频电切或钳除,无肿瘤复发。结论:结肠梗阻时急诊肠镜检查通常是安全的,对于明确病因,选择合理的治疗措施极其重要。

Value of Colonofiberscope in the Etiological Diagnosis and Treatment of Colonic Obstruction

Objective:Obstruction of colon is the common emergency with multiple causes. This study focused on the value of colonofiberscope application in the obstruction of colon. Methods:Fifty-six cases with obstruction of colon diagnosed by barium enema were analyzed retrospectively. Among them, forty-six patients with colonic carcinoma underwent operation, 5 cases of colonic torsion were repositioned with colonofiberscope (4 cases) or operated, 4 cases of fecal impaction were treated conservatively, and one case of adhesive obstruction of jejunum was operated. Results:Three cases of ileus with colonic carcinoma died of multiple organ dysfunction within 24h postoperation. There were 3 cases of infection of incision, 1 case of disruptiong of wound, 2 cases of stoma bleeding, 4 cases of stoma stenosis, 6 cases of pulmonary infection. No anastomosis leak occurred. Mean follow-up period was 20 months. Fourteen polyps identified by colonofiberscope were resected endoscopiclly. No tumor recurrence was found.Conclusion:Emergency colonofiberscope is a safe examination for colonic obstruction. It is very helpful to identify the cause and to select reasonable treatment.