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目的探讨急性结肠穿孔的发病原因、临床特点和治疗方法。方法回顾性分析收治的22例结肠穿孔患者的临床资料。结果穿孔原因:肿瘤性54.5%(12/22),外伤性27.3%(6/22),粪块性9.1%(2/22),憩室炎4.5%(1/22),肠套叠4.5%(1/22)。穿孔部位:盲肠31.8%(7/22),横结肠18.2%(4/22),降结肠9.1%(2/22),乙状结肠40.9%(9/22)。全部急诊手术,I期彻底性手术7例(31.8%),分期彻底性手术11例(50%),穿孔修补+永久性近端造瘘或永久性穿孔肠曲外置术4例。术后肺部感染6例(27.3%),合并胸腔积液2例(9.1%)、急性呼吸窘迫综合征2例(9.1%),予穿刺抽液、呼吸机辅助呼吸等治疗后好转;膈下脓肿2例(9.1%),经B超引导穿刺置管引流后好转;切口感染10例(45.5%),经换药愈合7例,全层裂开Ⅱ期缝合3例;肠瘘1例,改行造口术后好转。全组治愈18例(81.8%),2例(9.1%)因感染性休克、多器官功能衰竭于术后21 h,3 d死亡,自动出院2例(9.1%)。结论提高对结肠穿孔的认识,及时正确诊断,尽早手术,选择合理手术方式是提高其治疗效果的关键。
Objective To investigate the causes, clinical features and treatment of acute colonic perforation. Methods The clinical data of 22 patients with perforation of colon were retrospectively analyzed. Results Perforation causes: 54.5% (12/22) of tumors, 27.3% (6/22) traumatic injuries, 9.1% (2/22) of fecal masses, 4.5% (1/22) of diverticulitis, 4.5% (1/22). Perforation site: cecum 31.8% (7/22), transverse colon 18.2% (4/22), descending colon 9.1% (2/22), sigmoid colon 40.9% (9/22). Seven cases (31.8%) underwent radical surgery, complete radical surgery in 11 cases (50%), perforation repair + permanent proximal ostomy or permanent perforation of the intestinal tract in 4 cases. Postoperative pulmonary infection in 6 patients (27.3%), pleural effusion in 2 cases (9.1%), acute respiratory distress syndrome in 2 cases (9.1%), to puncture fluid, ventilator assisted breathing and other treatment improved; diaphragm 2 cases (9.1%) underwent abscess, which was improved by B-guided catheterization; 10 cases (45.5%) were infected by incision, 7 cases were cured by dressing change, 3 cases were staged by split- , Diverted to improve after ostomy. Eighteen patients (81.8%) were cured and two patients (9.1%) were discharged spontaneously due to septic shock and multiple organ failure at 21 h and 3 d after surgery. Two patients (9.1%) were discharged spontaneously. Conclusion To improve the awareness of colonic perforation, timely and correct diagnosis, early surgery, choose a reasonable surgical approach is to improve the therapeutic effect of the key.