Li Liang, Xue Bing, Yang Chunxia, Han Zhongbo, Xie Hongqiang, Wang Meng
Department of Gastrointestinal Surgery and Zibo Central Hospital, Zibo, China.
Department of Internal Medicine, Zibo Central Hospital, Zibo, China.
J Laparoendosc Adv Surg Tech A. 2020 Nov;30(11):1153-1159. doi: 10.1089/lap.2020.0086. Epub 2020 Mar 24.
There are few studies on postoperative complications after colonoscopic perforation. We aimed to study clinical characteristics and treatment after colonoscopic perforation, and to determine risk factors for postoperative complications by surgical treatment of colonoscopy perforation. Cases with perforation within 7 days after colonoscopy from January 2017 to December 2019 were collected for retrospective analysis. Data regarding demography, clinical information, colonoscopy, perforation, and operation were collected. Single-factor analysis and Spearman correlation analysis were employed to determine the risk factors of postoperative complications. A total of 35,243 colonoscopy examinations were performed during the study period, of which 18 cases of colonoscopic perforation were included in the criteria. Most perforations occurred in the rectosigmoid junction (3 cases) and sigmoid colon (11 cases). All perforation patients received operational treatment, and the incidence of postoperative complications was 38.9%, but no deaths. There were 7 patients who developed postoperative complications. Spearman correlation analysis showed that preoperative medication of glucocorticoid and nonrectosigmoid perforation were positively related to postoperative complications ( < .05), while perforation diagnosed immediately and satisfying intestinal cleanliness were negatively related to it ( < .05). Perforation is a rare but serious complication of colonoscopy, which mostly occurs in the rectosigmoid junction and sigmoid colon. Laparoscopic primary repair is safe and feasible in resolving colonic perforation due to colonoscopy, and postoperative complications were significantly related to perforation site, preoperative medication of glucocorticoid, perforation diagnosis time, and intestinal cleanliness.
关于结肠镜检查穿孔术后并发症的研究较少。我们旨在研究结肠镜检查穿孔后的临床特征及治疗方法，并通过对结肠镜检查穿孔进行手术治疗来确定术后并发症的危险因素。收集2017年1月至2019年12月结肠镜检查后7天内发生穿孔的病例进行回顾性分析。收集有关人口统计学、临床信息、结肠镜检查、穿孔及手术的数据。采用单因素分析和Spearman相关性分析来确定术后并发症的危险因素。研究期间共进行了35243例结肠镜检查，其中18例结肠镜检查穿孔符合纳入标准。大多数穿孔发生在直肠乙状结肠交界处（3例）和乙状结肠（11例）。所有穿孔患者均接受了手术治疗，术后并发症发生率为38.9%，但无死亡病例。有7例患者发生了术后并发症。Spearman相关性分析显示，术前使用糖皮质激素和非直肠乙状结肠穿孔与术后并发症呈正相关（<0.05），而穿孔立即被诊断及肠道清洁度良好与术后并发症呈负相关（<0.05）。穿孔是结肠镜检查中一种罕见但严重的并发症，大多发生在直肠乙状结肠交界处和乙状结肠。腹腔镜一期修复术在解决结肠镜检查所致结肠穿孔方面安全可行，术后并发症与穿孔部位、术前使用糖皮质激素、穿孔诊断时间及肠道清洁度显著相关。
