结肠穿孔的急诊处理（附29例报告）

目的：探讨结肠穿孔的诊断和治疗方法。方法：回顾性分析我院1990年1月～2000年5月收治的29例结肠穿孔，探讨急诊处理的方法。结果：23例术前作腹腔穿刺，其中抽得粪样腹水18例，血性腹水5例，穿刺阳性率达100%。20例术前摄腹部X线平片，见膈下游离气体15例，阳性率为75%。29例均急诊手术，其中I期手术10例（穿孔修补 引流术4例，右半结肠切除吻合 引流术6例），II期手术19例（穿孔修补 双管造口 引流术7例，穿孔处双管造口 引流术11例，Hart-manns术 引流术1例）。死亡6例，死亡率为20.7%。结论：腹腔穿刺和腹部X线平片应作为术前诊断的常规。及时诊断，尽早手术，手术以简单为宜，有利于减少术后并发症，降低死亡率。

Emergent Management of the Perforation of Colon: A Report of 29 Cases

Objective: To study the diagnosis and management of perforation of the colon. Methods: 29 cases with colonic perforation were retrospectively reviewed. Results: Of the 29 patients, 23 were examined by abdominocentesis to make t he diagnosis, including 18 cases of fecal ascites and 5 cases of bloody ascites, the accuracy rate of which was 100%. 15 (75%) cases were found subdiaphragmatic f ree air by abdominal x-ray in 20 patients. Among all patients, 10 accepted prima ry operation including 4 cases of perforation repair +drainage, and 6 cases of p rimary resection+anastomosis and drainage, while other 19 cases underwent staged operation such as perforation repair + double-barreled colostomy+drainage or do uble-barreled colostomy+ drainage or Hartmanns+drainage. 6 patients died after o peration, mortality rate was 20.7%. Conclusion: Abdominocentesis and abdominal radiograph should be performed before operation to make sure diagnosis. Proper s urgical procedure should be taken promptly to reduce the mortality and morbidity .