- 期刊
Laparoscopic Primary Repair of Iatrogenic Colon Perforation
以腹腔鏡直接修補醫源性結腸穿孔
摘要
目的 大腸鏡檢查或治療的一個罕見但嚴重的問題是醫源性結腸穿孔。傳統上剖腹探查以直接修補或切除部份大腸是不可避免的。但若早期發現，有趨勢傾向直接以腹腔鏡手術修補。我們在此報告自己的經驗。 方法 回朔2003年12月至2008年11月，共有18個醫源性結腸穿孔在本院接受手術治療。其中14個接受剖腹探查後行部份大腸切除或直接修補；另4個接受診斷性腹腔鏡後直接以腹腔鏡手術修補。我們比較兩種手術之優劣。 結果 在開腹手術的14個病人中，有4個病人接受直接修補，其中1人合併橫結腸造廔口。另10人接受部份大腸切除，其中2人合併小腸造廔口。相對而這，4個接受腹腔鏡手術者，都直接以腹腔鏡手術修補。手術時間在兩組並無差異，流血量明顯在腹腔鏡手術組較少。開腹手術組的術後傷口感染率，術後腸阻塞率較高，住院天數較長；但未達統計差異。 結論 與傳統開腹手術，結腸穿孔用腹腔鏡手術修補結果近似。腹腔鏡手術治療因大腸鏡造作結腸穿孔是可以考慮的。
並列摘要
Purpose. Iatrogenic colon perforation is a rare but serious complication of colonoscopy. Surgical intervention is frequently performed using traditional exploratory laparotomy for repair or colectomy; however, the laparoscopic approach may be an alternative option. We report our experience with laparoscopic suture repair and evaluate its effects compared with open surgery. Methods. We retrospectively analyzed data for eighteen patients who underwent surgical repair after colonoscopy-induced iatrogenic colon perforation between December 2003 and November 2008. Fourteen patients received traditional exploratory laparotomies with primary repair or colectomy. Four patients underwent diagnostic laparoscopy and direct laparoscopic suture repair. The estimated perforation duration, operative time, and length of hospitalization were compared. Results. In the open surgery group, four patients underwent primary repair of the defect, one of whom added loop T-colostomy for fecal diversion. The others received colectomies, and fecal diversion with loop ileostomy was performed in two. In the laparoscopic group, four patients underwent laparoscopic primary intra-corporeal suture repair. Blood loss was statistically less significant during the laparoscopic approach and the operative times were not different. Although a higher wound infection rate along with more prolonged post-operative ileus and longer hospital stays were noted in the open method, the difference was not statistically significant due to the limited number of cases. Conclusion. An initial laparoscopic approach for diagnosis of iatrogenic perforations followed by laparoscopic colorraphy of the colon seems safe and efficacious when compared to open surgery. It is reasonable to consider laparoscopic repair of iatrogenic colon perforation as an alternative option.