临床军医杂志
臨床軍醫雜誌
림상군의잡지
CLINICAL JOURNAL OF MEDICAL OFFICER
2001年
1期
49-51
,共3页
乙状结肠自发穿孔%病因%鉴别诊断%治疗
乙狀結腸自髮穿孔%病因%鑒彆診斷%治療
을상결장자발천공%병인%감별진단%치료
目的 探讨乙状结肠自发性穿孔的病因、诊断、鉴别诊断及治疗方法。方法 结合文献回顾性分析我院1984年1月～2000年9月收治的11例乙状结肠自发性穿孔病人的临床资料。结果 11例病人均经手术探查证实乙状结肠穿孔，既往有慢性便秘史4例，合并轻度直肠脱垂1例，余6例无特殊记载；9例术前误诊为急性阑尾炎穿孔、上消化道穿孔、结肠癌穿孔、炎性穿孔或粪块性穿孔；2例单纯修补术后康复，7例术后2～3月行Ⅱ期闭瘘术后恢复，2例术后死亡。结论 乙状结肠自发性穿孔与病人本身乙状结肠所处的形态和位置有很大关系，其腹内压和肠管内压增高是该病的诱因；该病缺乏特异的临床表现及体征，提高术前确诊率的关键在于对本病有充分的认识；治疗以手术为主，术式根据病人的年龄、全身情况、腹腔污染程度、发病时间来定，以修补关闭穿孔或肠管切除吻合加乙状结肠造口术为最佳术式。
目的 探討乙狀結腸自髮性穿孔的病因、診斷、鑒彆診斷及治療方法。方法 結閤文獻迴顧性分析我院1984年1月～2000年9月收治的11例乙狀結腸自髮性穿孔病人的臨床資料。結果 11例病人均經手術探查證實乙狀結腸穿孔，既往有慢性便祕史4例，閤併輕度直腸脫垂1例，餘6例無特殊記載；9例術前誤診為急性闌尾炎穿孔、上消化道穿孔、結腸癌穿孔、炎性穿孔或糞塊性穿孔；2例單純脩補術後康複，7例術後2～3月行Ⅱ期閉瘺術後恢複，2例術後死亡。結論 乙狀結腸自髮性穿孔與病人本身乙狀結腸所處的形態和位置有很大關繫，其腹內壓和腸管內壓增高是該病的誘因；該病缺乏特異的臨床錶現及體徵，提高術前確診率的關鍵在于對本病有充分的認識；治療以手術為主，術式根據病人的年齡、全身情況、腹腔汙染程度、髮病時間來定，以脩補關閉穿孔或腸管切除吻閤加乙狀結腸造口術為最佳術式。
목적 탐토을상결장자발성천공적병인、진단、감별진단급치료방법。방법 결합문헌회고성분석아원1984년1월～2000년9월수치적11례을상결장자발성천공병인적림상자료。결과 11례병인균경수술탐사증실을상결장천공，기왕유만성편비사4례，합병경도직장탈수1례，여6례무특수기재；9례술전오진위급성란미염천공、상소화도천공、결장암천공、염성천공혹분괴성천공；2례단순수보술후강복，7례술후2～3월행Ⅱ기폐루술후회복，2례술후사망。결론 을상결장자발성천공여병인본신을상결장소처적형태화위치유흔대관계，기복내압화장관내압증고시해병적유인；해병결핍특이적림상표현급체정，제고술전학진솔적관건재우대본병유충분적인식；치료이수술위주，술식근거병인적년령、전신정황、복강오염정도、발병시간래정，이수보관폐천공혹장관절제문합가을상결장조구술위최가술식。
Objective To study the cause, diagnosis, differential diagnosisand treatment of spontaneous perforation of sigmoid colon. Method The clinical data of 11 patients with spontaneous perferation of sigmoid colon admitted into our hospital from Jan. 1984 to Sep.2000 were analyzed retrospectively. Result 11 cases were all proved to be sick with spontaneous perforation of sigmoid colon by operation. Among them 4 cases had chronic oppilation history, 1 case was complicated by light proctoptoma and the rest 6 cases had no special record. 9 cases were misdiagnosed as perforation of acute appendicitis, perforation of upper respiratory tract, perforation of colon carcinoma, inflammatory perforation or fecal mass perforation. 2 cases recovered after repair. 7 cases recovered by phase Ⅱ fistula closure 2～3 months after operation. 2 cases died after operation. Conclusion Spontaneous perforation of sigmoid colon is closely retated to the form and position of the patient's sigmoid colon. The increase of intra-abdominal pressure and intra-intestinal pressure is the predisposing cause of the disease. This disease has no special clinical expression and symptoms. The key of diagnosis is to have a full knowing of the disease before operation. The main treatment is an operation. The mode of operation is determined according to patient's age, body status, degree of abdominal pollution, attack time. The best mode of operation is to repair and close the perforation or to resect and anastomose the intestinal canal and fistulize sigmoid colon.
