Schlöricke E, Bader F G, Hoffmann M, Zimmermann M, Bruch H-P, Hildebrand P
Universitätsklinikum Schleswig-Holstein, Klinik für Allgemeine Chirurgie, Lübeck, Deutschland.
Zentralbl Chir. 2013 Jun;138(3):257-61. doi: 10.1055/s-0031-1271380. Epub 2011 Apr 8.
Iatrogenic colon perforation is a rare but life-threatening complication of colonscopy. As in other diseases, laparoscopic treatment has increasingly been propagated for the treatment of colonic disorders in the last years. The aim of this comparative study was to answer the question of whether laparoscopic surgical treatment may serve as a suitable treatment for the acute colon perforation comparable to open surgery.
The data of all patients who underwent surgery for iatrogenic colon perforation within a 13-year time period (1997-2009) were recorded prospectively and analysed retrospectively with regard to different perioperative parameters. In the following analysis the laparoscopically and open surgically treated patients were compared.
In the observation period 24 patients with iatrogenic colon perforation were treated laparoscopically and 12 patients with open surgery. There were no significant differences concerning age in both groups. In both groups resection of the affected region was preferred [open surgically: 58 % (n = 7), laparoscopically: 80 % (n = 19)]. The median operation time was 105 min (range: 35 - 180) for the open surgically treated patients and 165 min (90 - 420) for laparoscopic procedures (p = 0.006). In 4 cases of the laparoscopic group a conversion via laparotomy was -necessary. There was no significant difference concerning the hospital stay between both groups with 14.5 days (7-40) for the open surgical and 11 days (7-25) for the laparoscopic group. Concerning the postoperative morbidity a significantly higher incidence could be seen in the open surgical group (p < 0.0001).
An iatrogenic colon perforation mostly leeds to the immediate indication for a surgical treatment. The morbidity and mortality is -primarily determined through the appearance of postoperative complications due to delays in diagnostics and treatment. In this study the feasibility of a laparoscopic treatment could be shown. The laparoscopy with its minimal access trauma offers an enlargement of the diagnostics as well as a safe treatment of the perforation in most patients. However, the laparoscopic treatment especially in emergancy situations requires -advanced experience of the surgeon and always needs a critical benefit-risk consideration in the individual situation.
医源性结肠穿孔是结肠镜检查中一种罕见但危及生命的并发症。与其他疾病一样，近年来腹腔镜治疗在结肠疾病治疗中的应用越来越广泛。本比较研究的目的是回答腹腔镜手术治疗是否可作为与开放手术相当的急性结肠穿孔合适治疗方法这一问题。
前瞻性记录13年期间（1997 - 2009年）所有因医源性结肠穿孔接受手术患者的数据，并就不同围手术期参数进行回顾性分析。在以下分析中，对腹腔镜手术治疗患者和开放手术治疗患者进行比较。
在观察期内，24例医源性结肠穿孔患者接受了腹腔镜治疗，12例患者接受了开放手术。两组患者年龄无显著差异。两组均首选切除受影响区域[开放手术：58%（n = 7），腹腔镜手术：80%（n = 19）]。开放手术治疗患者的中位手术时间为105分钟（范围：35 - 180分钟），腹腔镜手术为165分钟（90 - 420分钟）（p = 0.006）。腹腔镜组有4例患者需要转为开腹手术。两组患者住院时间无显著差异，开放手术组为14.5天（7 - 40天），腹腔镜组为11天（7 - 25天）。关于术后发病率，开放手术组的发病率明显更高（p < 0.0001）。
医源性结肠穿孔大多导致立即进行手术治疗的指征。发病率和死亡率主要由诊断和治疗延迟导致的术后并发症出现情况决定。本研究表明了腹腔镜治疗的可行性。腹腔镜手术创伤极小，在大多数患者中既扩大了诊断范围，又能安全治疗穿孔。然而，腹腔镜治疗，尤其是在紧急情况下，需要外科医生有丰富经验，并且在个体情况下始终需要仔细权衡利弊。
