乙状结肠自发穿孔（附11例报告）

目的 探讨乙状结肠自发性穿孔的病因、诊断及治疗。方法 回顾性分析1984年1月－2000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例行单纯修补术后,9列行结肠造口及相关手术，其中7例术后2－3个月行二期闭瘘，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；治疗以手术米，术式根据病人年龄、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。

Spontaneous perforation of sigmoid colon(a report of 11 cases)

Objective To study the causes, diagnosis and treatment of the spontaneous perforation of sigmoid colon(SPSC). Methods The clinical data of 11 patients with SPSC admitted into our hospital from January. 1984 to September. 2000 were analyzed retrospectively. Results All the 11 cases of SPSC were proved by operation. Among them, 4 cases had chronic constipation history, 1 case complicated with mild proctoptoma before operation and the other 6 cases had no special records. 9 cases were misdiagnosed as perforation of acute appendicitis, perforation of upper gastroenteric tract, perforation of colon carcinoma, inflammatory perforation or fecal mass perforation. 2 cases recovered after repairing operation; of 9 cases underwent colostomy and other procedure, 7 cases recovered and colostomy closure was done 2-3 months after operation. 2 cases died after operation. Conclusions The occurrence of SPSC is closely related to the configuration and position of the patient's sigmoid colon. Increase of intra-abdominal pressure and intra-intestinal pressure are the predisposing causes of the disease. This disease has no special clinical manifestation. The key to diagnosis is a full knwledge of the disease before operation. The main treatment is operation. The mode of operation is determined according to patient's age, general condition, severity of abdominal pollution, attacking time. The best mode of operation is to repair and close the perforation or to resect and anastomose the bowel and colostomy.