Cappell M S, Ghandi D, Huh C
Department of Medicine, UMDNJ-Robert Wood Johnson (formerly Rutgers) Medical School, New Brunswick, USA.
Am J Gastroenterol. 1995 Jul;90(7):1130-4.
Our objective was to evaluate the safety of lower endoscopy after colonic surgery, which has been unstudied and unknown. Endoscopy could promote suture breakdown at sites of colonic anastomoses, ostia, or repair by colonic abrasion or stretch from endoscopic intubation, torque, and insufflation.
Risks versus benefits of lower endoscopy performed within 3 wk of colonic surgery were retrospectively analyzed at five medical centers in 36 patients undergoing sigmoidoscopy and 72 age-and-sex-matched controls, and in 16 patients undergoing colonoscopy and 32 age-and-sex-matched controls.
Sigmoidoscopy indications included rectal bleeding in 14, distal colonic obstruction in 12, and other in 10. Sigmoidoscopy provided the diagnosis in 18 (54%) of 33 cases (excluding three therapeutic sigmoidoscopies, control rate = 30%, p < 0.01, X2, including colon cancer in six and benign stricture in five. Sigmoidoscopy led to colonic surgery in nine and medical therapy changes in four. Colonoscopy indications included colonic bleeding in seven, colonic obstruction in five, and other in four. Colonoscopy provided the diagnosis in nine (56%, control rate = 56%, NS, X2). Colonoscopy led to colonic surgery in three and chemotherapy in one. Two endoscopic complications, unrelated to suture breakdown, occurred: An acutely ill patient developed hypotension during sigmoidoscopy which resolved with intravenous fluid resuscitation. A contained sigmoid diverticular perforation became a free perforation (requiring laparotomy) after colonoscopy. Both control groups had no endoscopic complications (NS, Fisher's exact test).
In this study, the benefits outweighed the risks of postoperative sigmoidoscopy and colonoscopy. Clinicians should use discretion and perform colonoscopy or sigmoidoscopy after colonic surgery, particularly bowel anastomosis, only for clinically important indications. Endoscopy is contraindicated when colonic wound dehiscence or bowel perforation is suspected.
我们的目的是评估结肠手术后进行低位内镜检查的安全性，此前该领域尚未有研究且情况不明。内镜检查可能会因结肠吻合口、造口部位的缝线破裂，或因内镜插管、扭转及充气导致的结肠磨损或拉伸而引起修复部位的缝线破裂。
对五家医疗中心的36例行乙状结肠镜检查的患者及72例年龄和性别匹配的对照者，以及16例行结肠镜检查的患者及32例年龄和性别匹配的对照者，回顾性分析结肠手术后3周内进行低位内镜检查的风险与获益情况。
乙状结肠镜检查的适应证包括14例直肠出血、12例远端结肠梗阻及10例其他情况。在33例病例中（不包括3例治疗性乙状结肠镜检查），乙状结肠镜检查确诊了18例（54%）（对照率 = 30%，p < 0.01，X²检验），其中包括6例结肠癌和5例良性狭窄。乙状结肠镜检查导致9例患者接受结肠手术，4例患者的治疗方案发生改变。结肠镜检查的适应证包括7例结肠出血、5例结肠梗阻及4例其他情况。结肠镜检查确诊了9例（56%，对照率 = 56%，无显著性差异，X²检验）。结肠镜检查导致3例患者接受结肠手术，1例患者接受化疗。发生了2例与缝线破裂无关的内镜并发症：1例病情严重的患者在乙状结肠镜检查期间出现低血压，经静脉补液复苏后缓解。1例乙状结肠憩室局限性穿孔在结肠镜检查后发展为游离穿孔（需行剖腹手术）。两个对照组均未出现内镜并发症（无显著性差异，Fisher精确检验）。
在本研究中，结肠手术后行乙状结肠镜检查和结肠镜检查的获益大于风险。临床医生应谨慎行事，仅在具有重要临床指征时，才在结肠手术后，尤其是肠吻合术后，进行结肠镜检查或乙状结肠镜检查。怀疑有结肠伤口裂开或肠穿孔时，禁忌行内镜检查。
