10 Year Experience of Iatrogenic Colon Perforation: Clinical Presentation and Management

大腸鏡造成醫源性大腸穿孔之十年經驗：臨床表現與處理方式

黃彥均(Yan-Jiun Huang) ； 黃約翰(John Huang) ； 梁金銅(Jin-Tung Liang)

《中華民國大腸直腸外科醫學會雜誌》 21卷4期 (2010/12) Pp. 149-154

https://doi.org/10.6312/SCRSTW.2010.21(4).09906

摘要

目的　大腸鏡造成醫源性大腸穿孔是令人害怕且有潛在致命性的病發症。大腸鏡在臨床使用率的增加使得醫源性大腸穿孔更容易被觀察到。這個研究的目的主要是探討其發生率、臨床表現與臨床處理的方式。
方法　針對1997年至2004年間，因進行大腸鏡檢查而引發醫源性結腸穿孔的35位病人，進行病歷紀錄的回溯性研究，以紀錄病人術前及術後的基本資料、接受大腸鏡檢查的原因、病人的潛在疾病、大腸鏡檢查資料、重大腹部手術病史、結腸穿孔診斷時間、手術後之發現、治療方法、併發症與結果。
結果　在此10年期間，台大醫院外科總共進行過12582次大腸鏡檢查，因為此項檢查而引發醫源性大腸穿孔的病人共有35位(0.27%)。其中32位醫源性大腸穿孔都是發生在施行診斷性大腸鏡的過程中。有22位病人在大腸鏡撿查後6小時內即被診斷出而另有兩位病人則是在鏡檢完後24小時被診斷出。腹痛和腹脹是兩個主要的臨床表現。直腸乙狀結腸交界處是穿孔最常見之處，其次是乙狀結腸降結腸交界處（分別是87% and 6%）。有27位病人接受大腸穿孔的直接修補、3位病人接受大腸穿孔的直接修補合併分流性大腸造口、1位病人接受右升結腸切除術、1位病人接受低位直腸切除術、1位病人接受保守治療。平均住院天數是15.6天。有一位病人住院超長其主要原因為吻合處滲漏。
結論　大腸鏡造成的醫源性大腸穿孔是一項很嚴重的病發症。快速正確的診斷及處理是確保病人有較好預後的一種有效的方式。醫源性大腸穿孔的發生率是0.27%。手術直接修補處理大腸鏡造成的大腸穿孔仍是目前處理的主要方式。

關鍵字

大腸 ； 穿孔 ； 大腸鏡

並列摘要

Purpose. Colonic perforation caused by colonoscopy is a potentially lethal and feared complication. Its increasing use is making iatrogenic perforations more common. This study aimed to determine the incidence, clinical presentation, and management of colonic perforations resulting from colonoscopy.
Methods. Aretrospective study of 35 consecutive patients (23 males, 12 females) with colorectal perforations due to colonoscopy was analyzed over a 10-year period (from 1997 to 2008). Pre- and post-operative data on these 35 patients with colonic perforations were collected. The medical records of the patients with procedure related colonic perforation were reviewed.
Results. A total of 12,582 colonoscopies were performed by colorectal surgeons during the 10 years of the study. 35 colonic perforations (23 males, 12 females) were diagnosed (0.27%). 32 occurred during diagnostic and 3 during therapeutic colonoscopy. 22 patients were diagnosed with a hollow organ perforation within 6 hours after colonoscopic study, while 4 cases of colonic perforation were found more than 24 hours after the study. Abdominal pain and distention were the most common complaints. Rectosigmoid junction was the most common site of perforation followed by the descending colon or sigmoid/descending junction (87% and 6%, respectively). All except three patients had emergency operation including primary repair of the perforated colon without a diverting colostomy in 27 patients, primary repair of the perforated site with a diverting colostomy in 3 patients, right hemicolectomy in 1 patient, low anterior resection in 1 patient, and conservative treatment in 1 patient. The average hospital stay was 15.6 days.
Conclusion. Colonic perforation is a serious complication following colonoscopy. Prompt diagnosis and management are essential to ensure outcome optimization. The incidence of colonic perforation was 0.27%. Surgical treatment with primary repair remains the mainstay management of colonic perforation.

並列關鍵字

Colon ； Perforation ； Colonoscopy