自发性大肠穿孔诊治体会：附9例报告

目的:探讨自发性大肠穿孔的诊治。方法:回顾性分析1994年以来收治的9例自发性大肠穿孔患者的临床资料。结果:9例均为60岁以上的老年患者，缺乏特异性临床表现，术前均未能明确诊断。既往有长期高血压、动脉硬化史4例，有习惯性便秘史6例。穿孔位于横结肠1例，降结肠1例，乙状结肠3例，直肠上段4例。治疗采用穿孔修补、肠管外置4例，穿孔修补加近段结肠造瘘5例。术后1例出现心律失常，2例肺部感染，1例切口感染，均经处理后恢复顺利而痊愈出院。结论:自发性大肠穿孔多见于老年患者；好发部位在直肠和乙状结肠；术前易误诊，应尽早剖腹探查；手术宜简单化，应加强术后管理。

Treatment of spontaneous perforation of the large intestine:a report of 9 cases

Objective To discuss the diagnosis and treatment of spontaneous perforation of the large intestine.Methods The clinical data of 9 cases with spontaneous perforation of the large intestine admitted into our hospital since 1994 were analyzed retrospectively.Results All the 9 cases were over 60 years of age,had no specific clinical manifestations,and were misdiagnosed preoperatively.Among them,4 cases had a(longstanding) history of hypertension and arteriosclerosis,and 6 cases had habitual constipation.There was 1 case with perforation of transverse colon,1 case of descending colon,3 cases of sigmoid colon,and 4 cases of upper rectum.Four cases underwent exteriorization after a simple closure of the perforation,while in the other 5 cases closure of the perforation was followed by a loop colostomy.The postoperative complications included cardiac arrhythmia(1 case),lung infection(2 cases),and infection of incisional wound(1 case).All cases recovered smoothly and were discharged.Conclusions Spontaneous perforation of the large intestine usually presents in old patients,and frequeatly occurs in the rectum and sigmoid colon.It is usually misdiagnosed preoperatively,and surgical intervention should be performed as soon as possible.The operation should be simple.It is crucial to intensify management after operation.