河北医学
河北醫學
하북의학
HEBEI MEDICINE
2014年
8期
1313-1317
,共5页
大肠穿孔%临床特征%病死率
大腸穿孔%臨床特徵%病死率
대장천공%림상특정%병사솔
Large intestine perforation%Clinical feature%Mortality
目的：研究大肠穿孔病例的临床特点，更好的指导临床工作。方法：回顾性分析我院经手术或尸体解剖证实的大肠穿孔病例，分析患者的性别、年龄、症状、入院时血压、心率、腹部体征、血常规结果、就诊到手术时间、穿孔原因和住院期间转归等情况。结果：本组共32例，男性23例，女性9例；平均年龄52．7±18．7岁；其中7例死亡。全部病例中仅22例术前或尸检前诊断为消化道穿孔。本组患者1例三处穿孔，2例两处穿孔，其余为1个穿孔部位；穿孔分布以乙状结肠、直乙交界处较多。穿孔原因：大肠癌12例（37．5％），其次是医源性损伤。28例（87．5％）患者腹痛是主要临床症状。体征分析出现腹肌紧张75％（24例），出现腹部压痛90．6％（29例），出现反跳痛65．6％（21例），仅37．5％（12例）腹部X现平片出现游离气体；入院时平均体温、平均收缩压、舒、白细胞计数、中性粒细胞百分比及血小板计数等存活组和死亡组无显著差异。死亡病例与存活病例相比较心率快，舒张压低（ P＜0．05）；24h内得到手术探查者存活率高（ F＝0．006）。结论：大肠穿孔患者诊断正确率低，死亡率高。造成大肠穿孔原因首位是大肠癌，其次是医源性损伤；大肠穿孔以单个穿孔多见，大肠穿孔临床表现不典型，腹膜炎的体征往往缺如，腹腔游离气体出现率低。早期手术干预可有效降低死亡率。
目的：研究大腸穿孔病例的臨床特點，更好的指導臨床工作。方法：迴顧性分析我院經手術或尸體解剖證實的大腸穿孔病例，分析患者的性彆、年齡、癥狀、入院時血壓、心率、腹部體徵、血常規結果、就診到手術時間、穿孔原因和住院期間轉歸等情況。結果：本組共32例，男性23例，女性9例；平均年齡52．7±18．7歲；其中7例死亡。全部病例中僅22例術前或尸檢前診斷為消化道穿孔。本組患者1例三處穿孔，2例兩處穿孔，其餘為1箇穿孔部位；穿孔分佈以乙狀結腸、直乙交界處較多。穿孔原因：大腸癌12例（37．5％），其次是醫源性損傷。28例（87．5％）患者腹痛是主要臨床癥狀。體徵分析齣現腹肌緊張75％（24例），齣現腹部壓痛90．6％（29例），齣現反跳痛65．6％（21例），僅37．5％（12例）腹部X現平片齣現遊離氣體；入院時平均體溫、平均收縮壓、舒、白細胞計數、中性粒細胞百分比及血小闆計數等存活組和死亡組無顯著差異。死亡病例與存活病例相比較心率快，舒張壓低（ P＜0．05）；24h內得到手術探查者存活率高（ F＝0．006）。結論：大腸穿孔患者診斷正確率低，死亡率高。造成大腸穿孔原因首位是大腸癌，其次是醫源性損傷；大腸穿孔以單箇穿孔多見，大腸穿孔臨床錶現不典型，腹膜炎的體徵往往缺如，腹腔遊離氣體齣現率低。早期手術榦預可有效降低死亡率。
목적：연구대장천공병례적림상특점，경호적지도림상공작。방법：회고성분석아원경수술혹시체해부증실적대장천공병례，분석환자적성별、년령、증상、입원시혈압、심솔、복부체정、혈상규결과、취진도수술시간、천공원인화주원기간전귀등정황。결과：본조공32례，남성23례，녀성9례；평균년령52．7±18．7세；기중7례사망。전부병례중부22례술전혹시검전진단위소화도천공。본조환자1례삼처천공，2례량처천공，기여위1개천공부위；천공분포이을상결장、직을교계처교다。천공원인：대장암12례（37．5％），기차시의원성손상。28례（87．5％）환자복통시주요림상증상。체정분석출현복기긴장75％（24례），출현복부압통90．6％（29례），출현반도통65．6％（21례），부37．5％（12례）복부X현평편출현유리기체；입원시평균체온、평균수축압、서、백세포계수、중성립세포백분비급혈소판계수등존활조화사망조무현저차이。사망병례여존활병례상비교심솔쾌，서장압저（ P＜0．05）；24h내득도수술탐사자존활솔고（ F＝0．006）。결론：대장천공환자진단정학솔저，사망솔고。조성대장천공원인수위시대장암，기차시의원성손상；대장천공이단개천공다견，대장천공림상표현불전형，복막염적체정왕왕결여，복강유리기체출현솔저。조기수술간예가유효강저사망솔。
Objective:Investigating clinical characteristic of patients with colon perforation to get expe-rience of diagnosis and treatment .Method:32 patients with large intestine perforation were included into the retrospective study in our Hospital .Diagnosis with colon perforation depended on result of surgery or autopsy . Patients’ data including sex, age, symptom, vital sign on admission, abdominal sign, routine analysis of blood, duration from visiting doctor to operating , occasion of perforating and outcome was collected and ana-lyzed.Result:Of 32 patients, 23 were male and 9 were female, with an average age of 52.7±18.7 years and 7 died in hospital .Most patients suffered with 1 lesion, except 1 case with 3 lesions and 2 cases with 2 le-sions.Sigmoid or juncture of rectum and sigmoid was major sites of perforation;12 (37.5%) patients were caused by tumor and 7 cases (21.9%) were induced by iatrogenic injury .22 cases (68.8%) were accurately diagnosis.30 (93.8 %) patients complained with abdominal pain .24 (75%) had abdominal sign with guar-ding, 29 (90.6%) with abdominal tenderness and 21 (65.6%) with rebound tenderness.Only 12 patients (37.5%) showed free air in X-ray film.Between survival and non-survival groups, diastolic pressure, heart rate and duration time waiting operation were significantly different; multiple logistic regression equation showed only duration time waiting operation affect mortality .Conclusion:Patients with colon perforation had a high mortality and low accuracy of diagnosis .The major sites of lesion were sigmoid and most patients caused by tumor .The major clinical manifestation is abdominal pain and free air in X-ray film of peritoneal cavity is uncommon .Early operation seems decrease mortality .
