Clinical features and treatment analysis of acute lower gastrointestinal perforation in the elderly
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摘要: 目的 探讨老年人下消化道穿孔的病因、临床特点、手术方式及结局，为临床治疗该病提供参考。方法 选取2018年1月—2023年6月医院急诊收治的老年急性下消化道穿孔患者54例为研究对象。采取回顾性分析方法，根据患者的消化道穿孔不同部位，将其分为小肠穿孔组与结直肠穿孔组，并对两组患者的一般资料、辅助检查、病因、治疗方案及结局等进行分析。结果 54例患者中，小肠穿孔20例，穿孔原因分别为异物9例、淋巴瘤4例、不明原因4例、憩室炎2例、炎症性肠病1例；结直肠穿孔34例，穿孔原因分别为结肠肿瘤19例、粪石性6例、医源性5例、憩室炎3例、异物1例。两组患者CT检查的阳性率均为100%；结直肠组炎症指标及乳酸水平高于小肠组。小肠穿孔组患者均通过穿孔修补或病变肠管切除吻合获得治愈，并发切口感染2例、腹腔残余脓肿1例。结直肠组行穿孔修补6例(5例医源性穿孔和1例憩室穿孔)，病变肠管切除、Ⅰ期吻合16例，病灶切除、肠造口术8例，仅肠造口术4例；结肠直组治愈28例，死亡6例；切口感染6例。结论 异物是导致老年人小肠穿孔的主要原因之一，肿瘤是结直肠穿孔的最主要原因，粪石、医源性所致结直肠肠穿孔亦占较高的比例。腹部CT阳性率较高，可作为首选辅助检查。对于小肠穿孔、右半结肠及憩室炎穿孔、医源性穿孔以及无合并严重营养不良、低蛋白血症、待吻合肠管血供良好的可切除肿瘤穿孔修补或切除后Ⅰ期吻合是安全的。Abstract: Objective By analyzing the etiology, clinical features, surgical methods and curative effects of lower digestive tract perforation in the elderly, it provides reference for clinical treatment of this disease.Methods A total of 54 elderly patients with acute lower gastrointestinal perforation admitted to the emergency department of our hospital from January 2018 to June 2023 were enrolled. The retrospective analysis method was adopted to divide the patients into small bowel perforation group and colorectal perforation group according to different parts of the digestive tract perforation, and the general information, auxiliary examinations, etiology, treatment plan and outcome of the two groups of patients were analyzed.Results A total of 20 cases of small intestine perforation were caused by foreign body in 9 cases, lymphoma in 4 cases, unknown cause in 4 cases, diverticulitis in 2 cases and inflammatory bowel disease in 1 case. There were 34 cases of colorectal perforation, which were caused by colon tumors in 19 cases, fecal lithosity in 6 cases, iatrogenic in 5 cases, diverticulitis in 3 cases, and foreign body in 1 case. The positive rate of CT examination in both groups was 100%. The colorectal group had higher inflammatory indexes and lactic acid levels than the small intestine group. All patients with small bowel perforation were cured by repair or anastomosis after bowel resection, and 2 cases were complicated by incision infection and 1 case of residual abscess in the abdominal cavity. In the colorectal group, 6 cases(5 cases of iatrogenic perforation and 1 case of diverticulum perforation) were repaired, and 16 cases of lesion bowel resection and stage Ⅰ anastomosis were performed, lesion resection and enterostomy in 8 cases, only enterostomy in 4 cases, 28 cases were cured in the rectal group, 6 cases died, and 6 cases were infected by incision.Conclusion Foreign body is one of the main causes of small bowel perforation in the elderly, tumor is the most important cause of colorectal perforation, and colorectal perforation caused by fecal stone and iatrogenic also accounts for a high proportion. Abdominal CT positivity is high and may be preferred as an adjunct. It is safe for perforation of the small intestine, perforation of the right half colon and diverticulitis, iatrogenic perforation, and resectable tumor perforation repair or stage Ⅰ anastomosis after resection without severe malnutrition, hypoproteinemia, and good intestinal blood supply.
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Key words:
- elderly /
- small intestine /
- colorectal /
- perforate
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表 1 两组下消化道穿孔的一般资料和辅助检查比较
X±S 项目 小肠穿孔组(20例) 结直肠穿孔组(34例) t P 性别/例(%) 0.7 0.38 男 13(65.0) 18(52.9) 女 7(35.0) 16(47.1) 年龄/岁 73.6±10.2 70.4±6.6 1.4 0.16 发病至手术时间/h 18.0(11.0，25.3) 26.0(9.6，68.0) 0.9 0.32 白细胞/(×109/L) 13.1±0.4 16.6±0.5 5.1 ＜0.01 降钙素原/(ng/mL) 1.7±0.3 9.0±1.4 3.2 0.03 乳酸/(mmol/L) 1.6±0.2 3.1±0.3 4.9 ＜0.01 
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表 2 两组患者临床结局
项目 小肠穿孔组(20例) 结直肠穿孔组(34例) 治愈/例(%) 20(100.0) 28(82.4) 死亡/例(%) 0 6(17.6) 住院天数/d 7.5±0.3 10.2±0.7 并发症/例(%) 3(15.0) 6(17.6)
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