Magdeburg Richard, Sold Moritz, Post Stefan, Kaehler Georg
Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
Scand J Gastroenterol. 2013 Jul;48(7):862-7. doi: 10.3109/00365521.2013.793737. Epub 2013 May 22.
To describe the experience of a single center regarding the feasibility of endoscopic closure of iatrogenic colonic perforations and to elucidate differences between the efficacy of endoscopic clip closure due to diagnostic or therapeutic colonoscopy.
A retrospective institutional computer-based search of records of colonoscopic perforation occurring between January 2004 and December 2011 was undertaken. Data on patients undergoing colonoscopy were entered into a clinical database. To further improve the detection of all cases of colon perforations, the authors also searched their separate surgical database for every patient with a colon perforation treated or operated on in the surgery department. Statistical significance was tested using either Fortran-Subroutine Fytest, chi-square testing or t-test.
Over 8 years, 22,924 patients underwent colonoscopy, of which 105 consecutive patients suffered iatrogenic perforation. Clip application was possible in 62 patients (81.58%) after perforation due to a therapeutic colonoscopy, whereas clip application was only possible in 9 patients (31.03%) after perforation due to a diagnostic colonoscopy. 4 out of 9 patients (44.44%) in the diagnostic group compared with 7 out of 62 patients (11.29%) after clipping a perforation during a therapeutic colonoscopy were sent to surgery.
The authors' data indicate significant differences in the potential for and success of endoscopic closure of iatrogenic perforations occurring during diagnostic or therapeutic colonoscopy. The frequency of surgery was significantly greater after clipping a perforation during a diagnostic colonoscopy.
描述单一中心关于内镜闭合医源性结肠穿孔可行性的经验，并阐明诊断性或治疗性结肠镜检查导致的内镜夹闭疗效差异。
对2004年1月至2011年12月期间发生的结肠镜穿孔记录进行基于机构计算机的回顾性检索。将接受结肠镜检查患者的数据录入临床数据库。为进一步提高对所有结肠穿孔病例的检测，作者还在其单独的外科数据库中搜索了在外科接受治疗或手术的每例结肠穿孔患者。使用Fortran子程序Fytest、卡方检验或t检验进行统计学显著性检验。
8年间，22924例患者接受了结肠镜检查，其中105例连续患者发生医源性穿孔。治疗性结肠镜检查后穿孔的62例患者（81.58%）可行夹子夹闭，而诊断性结肠镜检查后穿孔的患者中仅有9例（31.03%）可行夹子夹闭。诊断组9例患者中有4例（44.44%）与治疗性结肠镜检查时夹闭穿孔后62例患者中的7例（11.29%）被送去手术。
作者的数据表明，诊断性或治疗性结肠镜检查期间发生的医源性穿孔的内镜闭合可能性和成功率存在显著差异。诊断性结肠镜检查时夹闭穿孔后手术频率显著更高。
