Colorectal Surgery Section, General Surgery Department, Hospital Alemán de Buenos Aires, Av Pueyrredón 1640 (1118), Buenos Aires, Argentina.
World J Surg. 2010 Aug;34(8):1949-53. doi: 10.1007/s00268-010-0545-x.
Iatrogenic perforation due to colonoscopy is the most serious complication of this procedure. Usually, resolution of this event requires segmental resection. The laparoscopic approach could be an option to minimize the outcome of this complication. The aim of the present study was to assess the effectiveness of the laparoscopic approach in treating colonic perforations due to colonoscopy.
Between July 1997 and November 2008 data were collected retrospectively on all patients who underwent colonoscopy and had a perforation caused by the procedure. Patients with other complications after colonoscopy as well as other colonic perforations were excluded. According to the method employed for the approach, the series was divided in two groups: those treated by the laparoscopic approach (group I; GI) and those treated via laparotomy (group II; GII). Morbidity and recovery parameters were compared between the two groups. Statistical analysis was performed using Student's t-test and the chi square test.
A total of 14,713 colonoscopies were performed during the study period. Of these, 10,299 (73 %) were diagnostics and 4,414 (27%) were therapeutics. There were 20 (0.13%) iatrogenic perforations (GI = 14 versus GII = 6). The mean age of the patients was 62 +/- 12.1 years. There were no differences in patient demographics, co-morbidities, and American Society of Anesthesiologists (ASA) grades between the groups. Seventeen patients had segmental colectomy with primary anastomosis (GI: 13 versus GII: 4). One patient in each group had simple suture with diverting ileostomy, and one patient from GII underwent a Hartmann's procedure. Patients from GI had a shorter hospital stay (GI: 4.2 +/- 2.06 days versus GII 11.5 +/- 8.8 days; P = 0.007) and there were no differences in complication rate compared with GII (GI: 3 versus GII: 5; P = 0.058).
Laparoscopic colectomy is effective in resolving colonic perforation due to colonoscopy, and it might offer benefits over the open approach.
结肠镜检查导致的医源性穿孔是该操作最严重的并发症。通常，这种情况下需要进行节段性切除。腹腔镜方法可能是将该并发症的结果最小化的一种选择。本研究旨在评估腹腔镜方法治疗结肠镜检查引起的结肠穿孔的效果。
在 1997 年 7 月至 2008 年 11 月期间，回顾性收集了所有接受结肠镜检查并因该操作导致穿孔的患者的数据。排除了结肠镜检查后出现其他并发症和其他结肠穿孔的患者。根据所采用的方法，该系列分为两组：腹腔镜治疗组（组 I；GI）和剖腹手术治疗组（组 II；GII）。比较两组的发病率和恢复参数。使用学生 t 检验和卡方检验进行统计学分析。
在研究期间共进行了 14713 例结肠镜检查。其中，73%（10299 例）为诊断性，27%（4414 例）为治疗性。共有 20 例（0.13%）医源性穿孔（GI：14 例与 GII：6 例）。患者的平均年龄为 62±12.1 岁。两组患者的人口统计学特征、合并症和美国麻醉医师协会（ASA）分级无差异。17 例患者行节段性结肠切除术加一期吻合术（GI：13 例与 GII：4 例）。每组各有 1 例患者行单纯缝合加转流性回肠造口术，1 例 GII 患者行 Hartmann 手术。GI 组患者的住院时间更短（GI：4.2±2.06 天与 GII：11.5±8.8 天；P=0.007），并发症发生率与 GII 组无差异（GI：3 例与 GII：5 例；P=0.058）。
腹腔镜结肠切除术治疗结肠镜检查引起的结肠穿孔效果良好，可能优于开放手术。
