Wang Heng, Li Ang, Shi Xiaohui, Xu Xiaodong, Wang Hantao, Wang Hao, Yu Enda
Department of Colorectal Surgery, Seventh People's Hospital of Shanghai University of TCM, Shanghai 200433, China.
Department of Colorectal Surgery, Changhai Hospital of Second Military Medical University, Shanghai 200433, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jun 25;21(6):660-665.
To summarize the diagnosis and treatment of iatrogenic colonoscopic perforation (ICP).
Clinical data, treatment course and outcome of 17 patients who developed ICP following colonoscopic examination or operation at Department of Colorectal Surgery, Changhai Hospital from January 2000 to December 2013 were retrospectively analyzed.
During above 13 years, a total of 127 106 patients underwent colonoscopic examination or operation, of whom 17 cases (0.013%) had ICP. There were 8 males and 9 females with an average age of 65.2 (32-85) years. The interval between the onset of ICP and clinically diagnosed ICP was 0 to 6 days after performance. ICP occurred in 8 patients following colonoscopy operations, including simple colonic polyp excision, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), while in 9 patients following simple colonoscopy examination. Except for one patient who was immediately diagnosed with ICP through the finding of "yellow adipose tissue visible in the vision field" during operation,7 early cases (41.2%) were diagnosed by abdominal X-ray examination, and 9 later cases were confirmed by abdominal CT examination. The perforation sites included sigmoid colon in 5 cases, caecum in 3 cases, descending colon in 3 cases, descending and sigmoid junction in 2 cases, ileum in 1 case, splenic flexure in 1 case, sigmoid and rectum junction in 1 case, retum in 1 case. One case with ICP following ESD after resection of polyp in caecum was cured successfully with conservative treatment, including fasting, gastrointestinal decompression, fluid infusion, anti-infection and nutritional support. One case with ICP, which was found during colonoscopic operation and the perforation was immediately closed with titanium clip, received conservative treatment, including anti-infection and then was cured. Fifteen patients underwent surgery, including 8 patients with primary intention intestinal perforation repair, 4 patients with primary intention resection of associated intestine and anastomosis, 2 patients with primary intention resection of associated intestine and ostomy, 1 patient with primary intention intestinal perforation repair and ostomy. Postoperative abdominal incision infection occurred in 4 cases, pulmonary infection in 1 case, incision infection with cardiovascular event or urinary tract infection in 1 case each. All the patients were cured and discharged. Average hospital stay was 18.6(3-45) days.
ICP should be diagnosed by physical examination and imaging examination as soon as possible. For perforation during colonoscopic performance, colonoscopic titanium clip can be used for closure. Perforation repair is still the main procedure for ICP. If necessary, partial intestinal resection and anastomosis or ostomy can be selected.
总结医源性结肠镜穿孔（ICP）的诊断与治疗方法。
回顾性分析2000年1月至2013年12月在长海医院结直肠外科行结肠镜检查或手术后发生ICP的17例患者的临床资料、治疗过程及结果。
在上述13年期间，共有127106例患者接受结肠镜检查或手术，其中17例（0.013%）发生ICP。男性8例，女性9例，平均年龄65.2（32 - 85）岁。ICP发生至临床确诊的时间为操作后0至6天。8例ICP发生于结肠镜手术后，包括单纯结肠息肉切除、内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD），9例发生于单纯结肠镜检查后。除1例在手术中通过视野中可见“黄色脂肪组织”立即诊断为ICP外，7例早期病例（41.2%）通过腹部X线检查确诊，9例后期病例通过腹部CT检查确诊。穿孔部位包括乙状结肠5例、盲肠3例、降结肠3例、降结肠与乙状结肠交界处2例、回肠1例、脾曲1例、乙状结肠与直肠交界处1例、直肠1例。1例盲肠息肉切除术后行ESD发生ICP的患者经保守治疗成功治愈，包括禁食、胃肠减压、补液、抗感染及营养支持。1例在结肠镜手术中发现ICP且穿孔立即用钛夹封闭的患者接受保守治疗，包括抗感染，随后治愈。15例患者接受了手术，其中8例行一期肠穿孔修补术，4例行一期相关肠段切除吻合术，2例行一期相关肠段切除造口术，1例行一期肠穿孔修补术并造口术。术后发生腹部切口感染4例，肺部感染1例各发生切口感染合并心血管事件或泌尿系统感染1例。所有患者均治愈出院。平均住院时间为18.6（3 - 45）天。
应尽早通过体格检查和影像学检查诊断ICP。对于结肠镜操作过程中的穿孔，可使用结肠镜钛夹进行封闭。穿孔修补仍是ICP的主要治疗方法。必要时可选择部分肠切除吻合或造口术。
