Clements R H, Jordan L M, Webb W A
Department of Surgery, The Norwood Clinic, Inc., Birmingham, Alabama 35234, USA.
Am Surg. 2000 Jan;66(1):91-3.
The ideal management of suspected colon perforation following colonoscopy remains elusive because the incidence is only 0.1 to 2.0 per cent. The patient with obvious perforation deserves immediate exploration, but the patient with equivocal findings poses a diagnostic dilemma. We propose an algorithm based on the results of water-soluble contrast enema that allows for rapid, definitive surgical decision-making. If perforation is confirmed, early operation allows for primary repair without resection or colostomy, or if no perforation is identified, medical management can be undertaken with confidence. This algorithm should ensure that the surgical management of this potentially lethal complication is not unnecessarily delayed.
结肠镜检查后疑似结肠穿孔的理想处理方法仍不明确，因为其发生率仅为0.1%至2.0%。有明显穿孔的患者值得立即进行探查，但检查结果不明确的患者则会带来诊断难题。我们提出一种基于水溶性造影剂灌肠结果的算法，可实现快速、明确的手术决策。如果确认穿孔，早期手术可进行一期修复而无需切除或结肠造口术，或者如果未发现穿孔，则可放心地进行保守治疗。该算法应确保对这种潜在致命并发症的手术处理不会被不必要地延迟。
