Canadian Surgical Technologies & Advanced Robotics (CSTAR), 339 Windermere Road, P.O. Box 5339, London, ON, N6A 5A5, Canada.
Department of Surgery, Western University, London, ON, Canada.
Surg Endosc. 2019 Dec;33(12):3889-3898. doi: 10.1007/s00464-019-07064-7. Epub 2019 Aug 26.
The aim of this review is to evaluate and summarize the current strategies used in the management of colonoscopic perforations as well as propose a modern treatment algorithm.
Articles published between January 2004 and January 2019 were screened. A total of 167 reports were identified in combined literature search, of which 61 articles were selected after exclusion of duplicate and unrelated articles. Only studies that reported on the management of endoscopic perforation in an adult population were retrieved for review. Case reports and case series of 8 patients or less were not considered. Ultimately, 19 articles were considered eligible for review.
A total of 744 cases of colonoscopic perforations were reported in 19 major articles. The cause of perforation was mentioned in 16 articles. Colonoscopic perforations were reported as a consequence of diagnostic colonoscopies in 222 cases and therapeutic colonoscopies in 248 cases. The site of perforation was mentioned in 486 cases. Sigmoid colon was the predominant site followed by the cecum. The management of colonoscopic perforations was reported in a total of 741 patients. Surgical intervention was employed in 75% of the patients, of these 15% were laparoscopic and 85% required laparotomy. The predominant surgical intervention was primary repair.
Management strategies of colon perforations depend upon the etiology, size, severity, location, available expertise, and general health status. Usually, peritonitis, sepsis, or hemodynamic compromise requires immediate surgical management. Endoscopic techniques are under continuous evolution. Newer developments have offered high success rate with least amount of post-procedure complications. However, there is a need for further studies to compare the newer endoscopic techniques in terms of success rate, cost, complications, and the affected part of colon.
本综述旨在评估和总结目前用于管理结肠镜穿孔的策略，并提出一种现代治疗算法。
筛选 2004 年 1 月至 2019 年 1 月期间发表的文章。在联合文献检索中总共确定了 167 份报告，在排除重复和不相关的文章后，有 61 篇文章被选中。仅检索了报道成人人群内镜穿孔管理的研究。未考虑病例报告和 8 例或更少的病例系列。最终，有 19 篇文章被认为符合审查条件。
在 19 篇主要文章中报告了 744 例结肠镜穿孔。16 篇文章提到了穿孔的原因。222 例穿孔是在诊断性结肠镜检查中发生的，248 例是在治疗性结肠镜检查中发生的。486 例报告了穿孔的部位。乙状结肠是主要部位，其次是盲肠。741 例患者报告了结肠镜穿孔的处理方法。75%的患者采用了手术干预，其中 15%为腹腔镜，85%需要剖腹手术。主要的手术干预是一期修复。
结肠穿孔的治疗策略取决于病因、大小、严重程度、位置、可利用的专业知识和一般健康状况。通常，腹膜炎、败血症或血流动力学不稳定需要立即进行手术治疗。内镜技术在不断发展。新的发展为最小化术后并发症提供了较高的成功率。然而，需要进一步的研究来比较新的内镜技术在成功率、成本、并发症和受影响结肠部位方面的差异。
