摘要
目的评价急诊肠镜诊疗技术在急性结直肠梗阻中的应用价值。方法复旦大学附属中山医院内镜中心2002年7月至2010年7月为459例急性结直肠梗阻患者施行了急诊肠镜检查和治疗，回顾性分析病历资料，评价其安全性和有效性。结果急诊肠镜检查的成功率100％（459／459），无检查相关穿孔等并发症发生。结直肠癌占71．3％（327／459）、乙状结肠扭转占11．3％（52／459）、膈疝占0．4％（2／459）、先天性巨结肠占0．6％（3／459）、粪石性梗阻占2．7％（12／459）、无异常发现占13．7％（63／459）。肠镜下获得治疗的患者比例83．2％（385／459），包括结直肠癌327例、乙状结肠扭转52例和先天性巨结肠3例。操作成功率95．8％（369／385），并发症发生率1．4％（5／385），无操作相关死亡病例。在327例结直肠癌患者中，93．9％（307／327）经肠镜下引流术（支架或肠梗阻导管引流）避免了急诊手术和腹壁结肠造瘘，其中232例患者在内镜引流术后获得了Ⅰ期手术切除，另75例因肿瘤较为晚期，选择了放／化疗或最佳支持治疗。结论急诊肠镜技术在诊断和治疗急性结直肠梗阻中具有安全、有效等特点，除可明确病因外，还能施行各种有效的治疗措施，应予推荐。
Objective To assess the application value of emergency colonoscopy in the diagnosis and treatment of acute colorectal obstruction. Methods A total of 459 patients with acute colorectal obstruction received emergent colonoscopy from July 2002 to July 2010. The safety and effective rates were analyzed. Results The diagnostic rate of successful emergency colonoscopy was 100% （459/459） without any complication. Colorectal cancer were found in 7 h 3 % cases （327/459）, volvulus of sigmoid in 1 h 3 % （52/459）, diaphragmatocele in 0.4% （ 2/459 ）, megacolon congenitum in 0. 6% （ 3/459 ）, fecal obstruction in 2. 7% （12/459） and none in 13.7% （63/459）. The therapeutic rate of colonoscopy was 83.2% （385/459）. There were colorectal cancer （n =327）, volvulus of sigmoid （n =52） and megacolon congenitum （n = 3）. The successful treatment rate was 95.8% （369/385） and the complication rate 1.4% （5/385）. Among all colorectal cancers, 93.9% （307/327） received endoscopic drainage （mental stents or drainage tube） so as to avoid emergency operations and stoma. And 232 cases underwent phase I operation and another 75 cases received chemotherapy or supportive treatment. Conclusion Emergency colonoscopy is an effective, safe, minimal invasive approach for diagnosing and managing acute colorectal obstruction.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第8期524-527,共4页
National Medical Journal of China
关键词
肠梗阻
结肠镜检查
急诊处理
支架
引流术
Intestinal obstruction
Colonoscopy
Emergency treatment
Stents
Drainage
