结肠自发性穿孔的诊断和治疗_West China Medical Journal

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彭俊文 , 周长青

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Keywords：

自发性肠穿孔; 结肠穿孔; 腹膜炎; 急腹症

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【摘要】　目的　总结结肠自发性穿孔的病因、诊断和治疗方法。　方法　回顾性分析2000年－2010年收治的9例因自发性结肠穿孔接受急诊剖腹探查手术患者的临床资料。　结果　平均发病年龄67.6岁（55～84岁），5例有慢性便秘病史；患者均以突发性腹痛起病，2例得到术前确诊。1例行穿孔修补术，6例行穿孔修补或穿孔肠段切除加近端结肠造瘘术，2例行Hartmann手术。治愈出院6例，2例切口感染，1例严重感染。　结论　自发性结肠穿孔好发于老年长期便秘史者，通常预后不良，且术后病死率较高。早期发现和手术治疗、彻底的腹腔内冲洗和严密的术后管理是改善预后的重要因素。

Citation： 彭俊文,周长青. 结肠自发性穿孔的诊断和治疗. West China Medical Journal, 2011, 26(7): 1076-1077. doi: Copy

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1. 　Maurer CA, Renzulli P, Mazzucchelli L, et al. Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon [J]. Dis Colon Rectum, 2000, 43(7): 991-998.
2. 　Haddad R, Bursle G, Piper B. Stercoral perforation of the sigmoid colon [J]. ANZ J Surg, 2005, 75(4): 244-246.
3. 　Yano T, Wakabayashi H, Yachida S, et al. A stercoral perforation of the colon with an obvious faecal mass diagnosed by computed tomography [J]. ANZ J Surg, 2008, 78(3): 214-215.
4. 　Yang B, Ni HK. Diagnosis and treatment of spontaneous colonic perforation: analysis of 10 cases [J]. World J Gastroenterol, 2008, 14(28): 4569-4572.
5. 　Tokunaga Y, Hata K, Nishitai R, et al. Spontaneous perforation of the rectum with possible stercoral etiology: report of a case and review of the literature [J]. Surg Today, 1998, 28(9): 937-939.
6. 　Serpell JW, Nicholls RJ. Stercoral perforation of the colon [J]. Br J Surg, 1990, 77(12): 1325-1329.
7. 　Huang WS, Wang CS, Hsieh CC, et al. Management of patients with stercoral perforation of the sigmoid colon: report of five cases [J]. World J Gastroenterol, 2006, 12(3): 500-503.
8. 　Durrans D, Redmond EJ, Marshman L. Stercoral perforation of the colon [J]. Br J Surg, 1991, 78(9): 1148.
9. 　Patel VG, Kalakuntla V, Fortson JK, et al. Stercoral perforation of the sigmoid colon: report of a rare case and its possible association with nonsteroidal anti-inflammatory drugs [J]. Am Surg, 2002, 68(1): 62-64.
10. 　Chen JH, Shen WC. Rectal carcinoma with stercoral ulcer perforation[J]. Hepatogastroenterology, 2000, 47(34): 1018-1019.
11. 　冯延昌, 魏元明, 刘志民, 等. 实用临床腹部外科少见病学[M]. 北京: 中国医药科技出版社, 2000: 206-207.

West China Medical Journal

结肠自发性穿孔的诊断和治疗

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