Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
Surg Endosc. 2010 May;24(5):1177-85. doi: 10.1007/s00464-009-0746-2. Epub 2009 Nov 14.
Colonic perforation is an uncommon but serious colonoscopy-associated complication. This study assessed the effectiveness of conservative management with endoscopic clipping for colonoscopy-associated perforations.
Clinical manifestations and management outcomes were assessed for 38 patients with colonoscopy-associated colonic perforations that occurred between January 2001 and April 2008 at the Asan Medical Center, Seoul, Korea. These perforations were classified as endoscopically evident, endoscopically suspected, and radiologically proven.
Of the 38 perforations, 19 were endoscopically evident, 9 were endoscopically suspected, and 10 were radiologically proven but without endoscopic evidence. Of the 19 patients with endoscopically evident perforations, 13 (68.4%) underwent endoscopic closure with clips, and all improved without surgery. All nine patients with endoscopically suspected perforations underwent endoscopic closure, and eight (88.9%) improved without surgery. Of the 10 radiologically proven perforations, 7 were detected within 1 day after colonoscopy. All the patients improved without surgery. However, two of the three patients with delayed perforations required emergency laparotomy. Consequently, of the 38 patients with perforations, 29 (76.3%) improved without surgery. Of the 28 patients with endoscopically evident or suspected perforations, conservative management was successful for 21 (95.5%) of the 22 patients with effective clipping, but for none (0%) of the 6 patients without clipping.
Conservative management by immediate endoscopic closure with clips can be effective for the treatment of colonic perforations detected during colonoscopy. Conservative management also may be tried cautiously for stable patients who have radiologically proven colonoscopy-associated perforations without endoscopic evidence.
结肠穿孔是一种少见但严重的结肠镜相关并发症。本研究评估了内镜夹闭保守治疗在结肠镜相关穿孔中的疗效。
评估了 2001 年 1 月至 2008 年 4 月在韩国首尔的 Asan 医疗中心发生的 38 例结肠镜相关结肠穿孔患者的临床表现和治疗结果。这些穿孔分为内镜下明显、内镜下疑似和放射学证实。
38 例穿孔中，19 例为内镜下明显，9 例为内镜下疑似，10 例为放射学证实但无内镜证据。19 例内镜下明显穿孔患者中，13 例（68.4%）接受内镜夹闭治疗，所有患者均无需手术而痊愈。9 例内镜下疑似穿孔患者均接受内镜夹闭治疗，8 例（88.9%）无需手术而痊愈。10 例放射学证实穿孔中，7 例在结肠镜检查后 1 天内发现。所有患者均无需手术而痊愈。然而，3 例迟发性穿孔患者中有 2 例需要紧急剖腹手术。因此，38 例穿孔患者中，29 例（76.3%）无需手术而痊愈。28 例内镜下明显或疑似穿孔患者中，22 例有效夹闭患者中有 21 例（95.5%）保守治疗成功，但 6 例未夹闭患者无一例成功。
即时内镜夹闭可有效治疗结肠镜检查时发现的结肠穿孔。对于无内镜证据的稳定放射学证实的结肠镜相关穿孔患者，也可谨慎尝试保守治疗。
