Clinical Outcome of Colon Perforation Due to Colonoscopy and Barium Enema

大腸鏡與鋇劑灌腸X光攝影時所造成的大腸穿孔之臨床結果

鄭慧雲(Hui-Yun Cheng) ； 施壽全(Shou-Chuan Shih) ； 張文熊(Wen-Hsiung Chang) ； 林錫泉(Ching-Chung Lin) ； 朱正心(Cheng-Hsin Chu) ； 王蒼恩(Tsang-En Wang)

《臺灣消化醫學雜誌》 26卷2期 (2009/06) Pp. 180-187

https://doi.org/10.6557/GJT.200906_26(2).0006

摘要

背景與目的：穿孔是做大腸鏡時的併發症之一，若做診斷性大腸鏡時，其發生率約爲0.0-0.3%；在治療性大腸鏡時，發生率約上升至0.5-3%。儘管穿孔的發生率很低，但隨著大腸鏡使用率的上升，也使得因做大腸鏡而受傷的比率隨之上升。鋇劑灌腸X光攝影可能會同時造成直腸和結腸受傷，其比率約爲0.2-0.4%。本研究在一個醫學中心中，測定其做大腸鏡或鋇劑灌腸X光攝影時，所造成的大腸穿孔之盛行率、臨床表現狀況、穿孔位置、處置和結果等。
方法：於200年至2005年之間的5年中，只要病人有因大腸鏡或鋇劑灌腸X光攝影所造成的大腸直腸穿孔的醫療記錄，全都納入試驗回顧之內。
結果：3位男性、9位女性共32位年齡爲60±5歲的病人，因大腸鏡（26病人）或鋇劑灌腸X光攝影（6病人）造成大腸穿孔。關於大腸穿孔發生率，診斷性大腸鏡，佔0.%（6位）；爲息肉切除，佔4.6%（0位）；做鋇劑灌腸X光攝影，佔0.02%（6位）。出現異常疼痛（28例，佔87%），逐漸異常膨脹（4例，佔44%）和發燒(5例，佔8%)是發生頻率最高的症狀，而腔室外積氣（26例，佔8%）是最常見的放射線學發現。最常發生穿孔的部分爲乙狀結腸（7例，佔53%）。3位病人以非手術方式處置；29位病人需進行手術處理，其中24位於24小時內進行手術。主要的併發症爲傷口感染、表層皮膚裂開或膿瘡等，發生率爲3%（32位病人有0位發生）。沒有病人死亡。可預測會有致病或病發症的因子爲：延遲診斷、老年、大範圍腹膜感染、先前有開刀病史及有併存的疾病等。
結論：迅速地確認及處置對於降低致病率是極其重要的。如果在不熟練的技術下，大腸穿孔的發生會有顯著地臨床影響及作用，且必須持續追蹤並降低這種情況的發生率。

關鍵字

大腸穿孔 ； 大腸鏡 ； 鋇劑灌腸X光攝影

並列摘要

Background and aim: Perforation as a complication of colonoscopy is estimated to occur in 0.01% to 0.3% of diagnostic procedures and up to 0.15% to 3% after therapeutic colonoscopy. Barium enema investigation can also produce both rectal and colonic injuries and incidences vary from 0.2% to 0.4%. We investigated the incidence, clinical presentation, location, management and outcome of colonic perforations resulting from colonoscopy or barium enema occurring in one medical center.
Methods: The medical records of all patients with colorectal perforation due to colonoscopy or barium enema seen over a 5-year period (between January 2001 and December 2005) were reviewed.
Results: Thirty-two patients, 13 males and 19 female aged 60±15 years, sustained colonic perforation resulting from colonoscopic procedures (26 patients) or barium enema (6 patients). The incidence of colonic perforation was 0.1% (16/16013) by diagnostic procedure, 4.6% (10/218) by polypectomy and 0.02% (6/25992) by barium. Abdominal pain 87% (28/32), progressive abdominal distension 44% (14/32) and fever 15% (5/32) were the most frequent symptoms encountered, while extraluminal air, 81% (26) was the most common radiologic finding. The most frequent site of perforation was the sigmoid colon in 53% (17) of patients. Of the patients with colon perforation, 29 underwent surgery, including 24 patients who underwent surgery within 24 hours after perforation while three patients were managed non-operatively. Major morbidity (complications) including wound infection, superficial skin dehiscence and abscess occurred in 31% (10 of 32 patients). There was no mortality. Factors related with major morbidity or complications of colonic perforation included delayed diagnosis, old age, extensive peritoneal contamination, history of previous surgery and underlying comorbidities (P＜0.05).
Conclusion: Prompt recognition and management of colon perforation plays a vital role in decreasing morbidity. Colonic perforation does occur, especially under unskilled hands with significant clinical impact and efforts should be made to detect and reduce the frequency of this condition.

並列關鍵字

colon perforation ； colonoscopy ； barium enema