乙状结肠自发穿孔11例

目的　探讨乙状结肠自发性穿孔的病因、诊断、鉴别诊断及治疗方法。方法　结合文献回顾性分析我院 1984年 1月～ 2 0 0 0年 9月收治的 11例乙状结肠自发性穿孔病人的临床资料。结果　 11例病人均经手术探查证实乙状结肠穿孔 ,既往有慢性便秘史 4例 ,合并轻度直肠脱垂 1例 ,余 6例无特殊记载 ;9例术前误诊为急性阑尾炎穿孔、上消化道穿孔、结肠癌穿孔、炎性穿孔或粪块性穿孔 ;2例单纯修补术后康复 ,7例术后 2～ 3月行Ⅱ期闭瘘术后恢复 ,2例术后死亡。结论　乙状结肠自发性穿孔与病人本身乙状结肠所处的形态和位置有很大关系 ,其腹内压和肠管内压增高是该病的诱因 ;该病缺乏特异的临床表现及体征 ,提高术前确诊率的关键在于对本病有充分的认识 ;治疗以手术为主 ,术式根据病人的年龄、全身情况、腹腔污染程度、发病时间来定 ,以修补关闭穿孔或肠管切除吻合加乙状结肠造口术为最佳术式

11 Cases with Spontaneous Perforation of Sigmoid Colon

Objective To study the cause, diagnosis, differential diagnosisand treatment of spontaneous perforation of sigmoid colon. Method The clinical data of 11 patients with spontaneous perferation of sigmoid colon admitted into our hospital from Jan. 1984 to Sep.2000 were analyzed retrospectively. Result 11 cases were all proved to be sick with spontaneous perforation of sigmoid colon by operation. Among them 4 cases had chronic oppilation history, 1 case was complicated by light proctoptoma and the rest 6 cases had no special record. 9 cases were misdiagnosed as perforation of acute appendicitis, perforation of upper respiratory tract, perforation of colon carcinoma, inflammatory perforation or fecal mass perforation. 2 cases recovered after repair. 7 cases recovered by phase Ⅱ fistula closure 2～3 months after operation. 2 cases died after operation. Conclusion Spontaneous perforation of sigmoid colon is closely retated to the form and position of the patient's sigmoid colon. The increase of intra-abdominal pressure and intra-intestinal pressure is the predisposing cause of the disease. This disease has no special clinical expression and symptoms. The key of diagnosis is to have a full knowing of the disease before operation. The main treatment is an operation. The mode of operation is determined according to patient's age, body status, degree of abdominal pollution, attack time. The best mode of operation is to repair and close the perforation or to resect and anastomose the intestinal canal and fistulize sigmoid colon.