Incidence and Management of Iatrogenic Colonoscopic Perforations

大腸鏡造成之醫源性大腸破裂的發生率及處理

林怡成(I-Chen Lin) ； 王瑞和(Jui-Ho Wang) ； 金台明(Tai-Ming King) ； 王心泰(Hsin-Tai Wang)

《中華民國大腸直腸外科醫學會雜誌》 21卷2期 (2010/06) Pp. 53-58

https://doi.org/10.6312/SCRSTW.2010.21(2).09821

摘要

目的　雖然大腸鏡造成醫源性大腸破裂的機率不高，但有可能會引起嚴重的併發症，甚至導致病人死亡。本篇研究在於討論本院大腸鏡造成大腸破裂的發生率及處理之相關經驗。
方法　此篇是回朔性的研究文章。收集本院從1998年1月至2008年12月發生大腸鏡造成大腸破裂的病人數共17人；分析病人相關基本資料、造成大腸破裂的原因、處置及預後。
結果　從1998年1月至2008年12月本院爲13442位患者執行大腸鏡檢查或治療。總共有17位病患發生大腸破裂，發生率爲0.13%。9位病人是給予保守性治療，包括禁食、靜脈輸液給予及抗生素治療；其中1位患者術後於住院期間因院內感染而導致死亡。破裂位置最常見是在乙狀結腸。
結論　大腸鏡造成之醫源性大腸破裂是少見但相對嚴重的併發症，早期發現及治療對於病人的預後相當重要。保守性治療適用於經過審慎篩選的病患。對於那些破洞比較大、生命徵象相對不穩定或是已有廣泛性腹膜炎的病人，手術治療是比較合適的。

關鍵字

併發症 ； 大腸鏡 ； 醫源性大腸破裂

並列摘要

Purpose. Although the incidence of iatrogenic colonoscopic perforation is low, it can result in severe complications and mortality. This study assessed the incidence and management of colonic perforations during an eleven year period at a medical center in southern Taiwan.
Materials and Methods. We reviewed all the medical records of patients receiving colonoscopies from January 1998 to June 2008. We collected the patient's demographic data, colonoscopic reports, and data regarding the location of perforations, their treatment and outcome.
Results. During the 11-year period, out of a total of 13442 colonoscopies, 17 cases (0.13%) involved colonoscopic perforations (15 men, 2 women). Of the 17 perforations, 11 (65%) occurred in the sigmoid colon. Eight (47%) of perforations were treated surgically and nine (53%) medically with intestinal rest and intravenous antibiotics. In the medically treated group, one patient failed conservative treatment and required surgical intervention. That patient underwent repair with proximal diversion. In the group treated surgically, four patients received primary repair with proximal diversion, two received colonic diversion, one resection with anastomosis, and one resection with end colostomy. One patient died from nosocomial pneumonia.
Conclusion. Iatrogenic colonoscopic perforation is a serious but rare complication. Its early recognition and treatment are essential. We found a perforation rate of 0.13%. Some patients with colonoscopic perforations may be safely treated nonoperatively, while others with large perforation or diffuse peritonitis may require surgery.

並列關鍵字

Colonoscopy ； Perforation ； Complication ； Iatrogenic