Laparoscopic Repair of Colonoscopic Perforation: Report of Three Cases

以腹腔鏡修補大腸鏡造成之大腸穿孔：三病例報告

吳建明(Jiann-Ming Wu) ； 陳國鋅(Kuo-Hsin Chen) ； 林恆甫(Heng-Fu Lin) ； 曾立銘(Li-Ming Tseng) ； 黃實宏(Shih-Horng Huang)

《Formosan Journal of Surgery》 39卷6期 (2006/12) Pp. 310-314

https://doi.org/10.29833/FJS.200612.0004

摘要

大腸鏡是診斷及治療大腸疾病最常用及最有效的工具。然而，文獻也報告了一些大腸鏡檢查或治療後所產生的併發症。其中大腸穿孔是最常見，也是最嚴重的併發症之一。如何治療大腸鏡造成的大腸穿孔仍有一些爭議。對於臨床症狀穩定且沒有廣泛性腹膜炎的病人有一些文獻報告可用保守方式治療成功。缺點是若保守治療失敗再接受手術則因為延遲治療而會增加手術的併發症，甚至死亡。對於已有廣泛性腹膜炎的病人一般建議直接手術治療。因為這樣的病人大多接受過大腸準備且接受手術的時間離穿孔發生的時間通常不長，所以一般可將大腸穿孔直接縫合修補。
隨著腹腔鏡器械及技術的發展，有越來越多的文獻報告以腹腔鏡手術來治療腸胃道的穿孔成功。在此我們報告三個做完大腸鏡檢查後發生大腸穿孔的病例，應用腹腔鏡體內縫合的技術而以微創手術成功的治療了這三位病人。

並列摘要

Colonoscopy is the single most useful tool for both diagnosis and treatment of diseases of the colon. However, several complications may occur after colonoscopic examination or intervention. Colonic perforation is one of the most common and severe complications. Treatment of colonic perforation related to colonoscopy is still controversial. Conservative treatment with good results has been reported for patients who were clinically stable and did not have generalized peritoneal signs. However, direct surgical intervention is recommended for patients with diffuse peritonitis. Primary suture repair of colonic perforation is usually feasible because contamination is not severe due to previous colonic preparation; furthermore, surgery is usually performed shortly after perforation occurs. In this era of minimally invasive surgery, therefore, successful laparoscopic repair of colonic perforation after colonoscopy has been reported more and more frequently. We present three patients who had colonic perforation after colonoscopic examination and were treated successfully by laparoscopic suture repair. The literatures are also reviewed for the optimal treatment of colonoscopic perforation.

並列關鍵字

colonic perforation ； colonoscopy ； laparoscopy