Donckier V, André R
Department of Digestive Surgery, Centre Hospitalier Universitaire de Tivoli, La Louvière.
Acta Chir Belg. 1993 Mar-Apr;93(2):60-2.
We describe the treatment of 9 patients who underwent endoscopic perforation of the large bowel. All perforations occurred in patients with colonic diverticulosis or during polypectomy. The choice between conservative or surgical management essentially depends on clinical criteria. Conservative treatment, clinical observation, broad spectrum antibiotics and parenteral diet, is recommended for patient in good general condition and without any sign of peritoneal irritation. Free intraperitoneal gas on X-ray is not an indication for laparotomy. On the other hand, the development of peritonism or clinical deterioration under medical treatment requires a surgical management. Primary suture of the perforation can be performed if the colon was well cleansed for colonoscopy, if the perforation is small and if there is no suspicion of underlying carcinoma. In the other cases, resection including the perforation must be recommended.
我们描述了9例接受大肠内镜穿孔治疗的患者情况。所有穿孔均发生在患有结肠憩室病的患者或息肉切除术中。保守治疗或手术治疗的选择主要取决于临床标准。对于一般状况良好且无任何腹膜刺激征象的患者，建议采用保守治疗，即临床观察、广谱抗生素及肠外营养支持。X线显示腹腔内有游离气体并非剖腹手术的指征。另一方面，若在药物治疗过程中出现腹膜炎或临床病情恶化，则需要进行手术治疗。如果结肠镜检查前结肠已充分清洁、穿孔较小且无潜在癌肿可疑，可对穿孔进行一期缝合。在其他情况下，则建议行包括穿孔部位在内的肠段切除术。
