结肠穿孔40例手术治疗体会

目的探讨急诊手术治疗不同病因致结肠穿孔的手术方式和治疗方法。方法对40例不同原因导致的结肠穿孔患者的临床资料进行回顾性分析。对8例自发性乙状结肠穿孔患者,行破裂肠管切除、远端关闭、近端造口术;对13例外伤性结肠破裂患者行Ⅰ期切除吻合术;对14例癌性结肠穿孔患者行Ⅰ期切除吻合术;对3例乙状结肠扭转肠坏死穿孔患者行分期手术;对2例纤维结肠镜检致穿孔患者行肠穿孔修补术。结果治愈36例,治愈率为90%;死亡4例,病死率为10%。结论对结肠穿孔的治疗根据患者的全身情况以及穿孔的病因选择合适的手术方式是治疗成功的关键。

Experience with Surgical Treatment of 40 Cases of Colonic Perforation

Objective To investigate the surgical approach to the treatment of different causes of colonic perforation. Methods Clinical data of 40 patients who underwent surgical treatment for different causes of colonic perforation were retrospectively analyzed. Among the 40 patients, 8 patients with spontaneous sigmoid perforation were treated with resection of ruptured bowel segment, distal closure and proximal ostomy, 13 patients with traumatic colon rupture and 14 patients with cancerous colon perforation with I stage resection and anastomosis, 3 patients with sigmoid colon volvulus-induced colon perforation with staging operation, and 2 patients with colonoscopy-induced colon perforation with perforation repair. Results Of the 40 patients, 36 （90%）were cured and 4 （ 10% ）died. Conclusion The appropriate surgical approach should be selected according to general conditions and perforation causes in patients with colonic perforation.