An Sung Bak, Shin Dong Woo, Kim Jeong Yeon, Park Sung Gil, Lee Bong Hwa, Kim Jong Wan
Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40 Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea.
Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyengchon-Dong Dongan-gu, Anyang-Si, Gyeonggi-Do, 431-070, Republic of Korea.
Surg Endosc. 2016 Jul;30(7):2914-21. doi: 10.1007/s00464-015-4577-z. Epub 2015 Oct 20.
The incidence of colonoscopic perforation has increased following the widespread use of colonoscopy for the diagnosis and treatment of colorectal disease. The purpose of our study was to compare the clinical outcomes between surgical and non-surgical treatment of colonoscopic perforation.
We retrospectively reviewed the medical records of patients with colonoscopic perforation, which was treated between January 2005 and December 2014. Patients were divided into two groups depending on whether they received non-surgical (conservative management or endoscopic clipping) or surgical (primary closure, bowel resection and anastomosis, and/or faecal diversion) initial treatment for the perforation. Conversion was defined as the change from a non-surgical to surgical procedure after treatment failure.
One hundred and nine patients were analysed. Surgical treatment was more common following diagnostic than therapeutic colonoscopic procedures (74.5 vs. 53.7 %, P = 0.023). Of 55 patients in the non-surgical group, 11 patients required conversion to surgery. The surgical group comprised 54 patients. The complication rate (P = 0.001), and the length of hospital stay (P < 0.001) were significantly greater in the patients requiring conversion than in the surgical group. Multivariate analysis showed that old age, American Society for Anesthesiologists score ≥ 3, and conversion were independent predictors of poor outcomes (P = 0.048, 0.032, and 0.001, respectively). Only perforation size was associated with conversion in multivariate analysis (P = 0.022).
It is important to select an appropriate treatment in patients with colonoscopic perforation. To avoid non-surgical treatment failure, surgery should be considered in patients with a large perforation. By decreasing the rate of conversion, we might reduce the complication and mortality rates associated with colonoscopic perforation.
随着结肠镜检查在结直肠疾病诊断和治疗中的广泛应用，结肠镜穿孔的发生率有所增加。我们研究的目的是比较结肠镜穿孔手术治疗和非手术治疗的临床结果。
我们回顾性分析了2005年1月至2014年12月期间接受治疗的结肠镜穿孔患者的病历。根据患者对穿孔接受的是非手术（保守治疗或内镜夹闭）还是手术（一期缝合、肠切除吻合和/或粪便转流）初始治疗，将患者分为两组。转换定义为治疗失败后从非手术治疗改为手术治疗。
共分析了109例患者。诊断性结肠镜检查后手术治疗比治疗性结肠镜检查更常见（74.5%对53.7%，P = 0.023）。在非手术组的55例患者中，11例患者需要转为手术治疗。手术组包括54例患者。需要转换治疗的患者的并发症发生率（P = 0.001）和住院时间（P < 0.001）明显高于手术组。多变量分析显示，老年、美国麻醉医师协会评分≥3分和转换治疗是预后不良的独立预测因素（分别为P = 0.048、0.032和0.001）。多变量分析中只有穿孔大小与转换治疗有关（P = 0.022）。
为结肠镜穿孔患者选择合适的治疗方法很重要。为避免非手术治疗失败，对于穿孔较大的患者应考虑手术治疗。通过降低转换治疗率，我们可能会降低与结肠镜穿孔相关的并发症和死亡率。
