手术治疗老年人自发性乙状结肠穿孔39例

目的：探讨老年人自发性乙状结肠穿孔的病因、临床特点和手术治疗方法。方法：完善术前准备剖腹探查，术中快速病理检查。根据病灶位置、大小及腹腔污染情况，行病变肠段切除远端关闭加近段结肠造瘘或穿孔修补加近段结肠双腔造瘘或穿孔段乙状结肠外置造痿。结果：行穿孔段乙状结肠外置造瘘1例，穿孔修补加近段结肠双腔造瘘3例，病变肠段切除远端关闭加近段结肠造瘘：35例。行切口减张缝合30例。术后发生切口感染18例，切口裂开再手术2例，死亡16例。结论：便秘是老年人自发性乙状结肠穿孔主要病因，泛影葡胺灌肠造影有利定性和定位诊断，及时手术是提高疗效的关健，手术方式应以病变肠段切除远端关闭加近段结肠造瘘为首选。

Operation for Spontaneous Perforation of Sigmoid Colon in 39 Elderly Patients

Objective To explore the etiopathogenesis, clinical characteristics and surgical methods of spontaneous perforation of the sigmoid colon in elderly patients. Methods After the preoperative preparation, instant exploratory laparotomy and quick pathological examination were done. The distal end was closed and proximal colostomy performed after resection of the performed sigmoid colon; or the proximal colostomy of dual - chamber after primary repair of the perforation was performed according to the position and size of focus of infection and the contaminated condition of the abdominal cavity. Results One patient underwent ostomy in perforating sigmoid colon; 3 patients underwent primary repair with proximal colostomy of dual - chamber; 35 patients underwent resection of the perforating sigmoid colon with distal end closure and proximal colostomy; 30 underwent relaxation suture. Eighteen patients had wound infection, 2 patients had disruption of the wound requiring reoperation; 16patients died. Conclusion Constipation is main etipathogenesis of spontaneous perforation of the sigmoid colon in elderly patients. Operation on time is the key point for improving curative effect, and the resection of perforaing siginoid colon with distal end closure and proximal colostomy should be the first choice.