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目的探讨预防性肠造口还纳术前结肠镜致肠穿孔的主要危险因素和应对策略。方法回顾性分析2013年9月-2015年4月我院结直肠肛门外科预防性肠造口还纳术前行结肠镜检查致肠穿孔4例患者的临床资料。结果结肠镜检查并发结肠穿孔4例,均为诊断性穿孔,其中1例穿孔部在横结肠盲端,3例在乙状结肠。4例患者均发现不同程度结直肠炎症表现,造口存在时间6-12个月,其中2例患者接受过结直肠肿瘤术后不同剂量的放疗。结论对于结直肠肿瘤术后预防性肠造口还纳患者,由于长期结肠旷置,且部分患者有放疗史,极容易形成旷置性肠炎和放射性肠炎,电子结肠镜检查容易导致肠穿孔。
Objective To investigate the main risk factors and treatment strategies of bowel perforation in patients with prophylactic bowel operation. Methods The clinical data of 4 patients with intestinal perforation who underwent colonoscopy for colorectal anorectal prophylaxis in our hospital from September 2013 to April 2015 were retrospectively analyzed. Results Colonoscopy complicated by colonic perforation in 4 cases, all diagnostic perforation, including 1 case of perforation in the transverse colon of the blind end, 3 cases in the sigmoid colon. All 4 patients showed different degrees of colorectal inflammation. The stoma existed for 6-12 months. Two of them received different doses of radiotherapy after colorectal cancer surgery. Conclusion For patients with colorectal neoplasms with prophylactic intestinal stomatitis, long-term colorectal exclusion and some patients with history of radiotherapy are likely to form open colonitis and radiation enteritis. Electronic colonoscopy easily leads to intestinal perforation.