Shi Xiaohui, Shan Yongqi, Yu Enda, Fu Chuangang, Meng Ronggui, Zhang Wei, Wang Hantao, Liu Lianjie, Hao Liqiang, Wang Hao, Lin Miao, Xu Honglian, Xu Xiaodong, Gong Haifeng, Lou Zheng, He Haiyan, Xing Junjie, Gao Xianhua, Cai Beili
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, No. 168, Changhai Road, Yangpu District, Shanghai, People's Republic of China,
Surg Endosc. 2014 Aug;28(8):2309-16. doi: 10.1007/s00464-014-3458-1. Epub 2014 Feb 25.
Colonoscopic perforation (CP) has a low incidence rate. However, with the extensive use of colonoscopy, even low incidence rates should be evaluated to identify and address risks. Information on CP is quite limited in China.
Our study aimed to determine the frequency of CP in colonoscopies performed by surgeons at a large teaching hospital in China over a 12-year period.
A retrospective review of medical records was performed for all patients who had CPs from 1 January 2000 to 31 December 2012. Iatrogenic perforations were identified mainly by abdominal X-ray or computed tomography scan. Follow-up information of adverse events post-colonoscopy was identified from the colorectal surgery database of our hospital. Patients' demographic data, colonoscopy procedure information, location of perforation, treatment, and outcome were recorded.
A total of 110,785 diagnostic and therapeutic colonoscopy procedures were performed (86,800 diagnostic cases and 23,985 therapeutic cases) within the 12-year study period. A total of 14 incidents (0.012%) of CP were reported (seven males and seven females), of which nine cases occurred during diagnostic colonoscopy (0.01%) and five after therapeutic colonoscopy (three polypectomy cases, one endoscopic mucosal resection, and one endoscopic mucosal dissection). Mean patient age was 67.14 years. One case of CP (7.14%) after colonoscopy polypectomy was treated using curative colonoscopy endoclips. Other patients underwent operations: six cases (46.15%) of primary repair, four cases (28.57%) of resection with anastomosis, and two cases (15.38%) of resection without anastomosis. No obvious perforation was found in one patient (7.69%). Surgeons attempted to treat one case laparoscopically but eventually resorted to open surgery. The postoperative course was uncomplicated in eight cases (57.14%) and complicated in six cases (42.86%) but without mortality.
CP is a serious but rare complication of colonoscopy. A perforation risk of 0.012% was found in our study. The optimal management of CP remains controversial. Treatment for CP should be individualized according to the patient's condition, related devices, and surgical skills of endoscopists or surgeons. Selective measures such as colonoscopy without intravenous sedation and decrease of loop formation can effectively reduce rates of perforation.
结肠镜穿孔（CP）的发生率较低。然而，随着结肠镜检查的广泛应用，即使是低发生率也应进行评估，以识别和应对风险。在中国，关于CP的信息相当有限。
我们的研究旨在确定中国一家大型教学医院的外科医生在12年期间进行的结肠镜检查中CP的发生频率。
对2000年1月1日至2012年12月31日期间所有发生CP的患者的病历进行回顾性分析。医源性穿孔主要通过腹部X线或计算机断层扫描来确定。结肠镜检查后不良事件的随访信息从我院结直肠外科数据库中获取。记录患者的人口统计学数据、结肠镜检查程序信息、穿孔部位、治疗方法和结果。
在12年的研究期间，共进行了110,785例诊断性和治疗性结肠镜检查（86,800例诊断病例和23,985例治疗病例）。共报告了14例CP事件（0.012%）（7例男性和7例女性），其中9例发生在诊断性结肠镜检查期间（0.01%），5例发生在治疗性结肠镜检查后（3例息肉切除病例，1例内镜黏膜切除术和1例内镜黏膜下剥离术）。患者平均年龄为67.14岁。1例结肠镜息肉切除术后的CP（7.14%）采用结肠镜治疗性内镜夹进行治疗。其他患者接受了手术：6例（46.15%）进行了一期修复，4例（28.57%）进行了切除吻合术，2例（15.38%）进行了切除未吻合术。1例患者（7.69%）未发现明显穿孔。外科医生曾尝试1例腹腔镜治疗，但最终改为开放手术。8例（57.14%）患者术后病程顺利，6例（42.86%）患者术后病程复杂，但均无死亡。
CP是结肠镜检查中一种严重但罕见的并发症。我们的研究发现穿孔风险为0.012%。CP的最佳管理仍存在争议。CP的治疗应根据患者情况、相关设备以及内镜医师或外科医生的手术技能进行个体化。诸如不使用静脉镇静剂进行结肠镜检查和减少肠襻形成等选择性措施可有效降低穿孔率。
