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頁籤選單縮合
題名 | The Clinical Values and Pitfalls of Colonoscopy--Our Five Year Experience=大腸鏡檢的臨床價值及陷阱--我們的五年經驗 |
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作者 | 田宇峰; 梁金銅; 張金堅; 王世名; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 31:3 民87.05-06 |
頁次 | 頁173-179 |
分類號 | 415.145 |
關鍵詞 | 大腸鏡檢; Colonoscopy; Colon perforation; Polyp; Colorectal carcinoma; |
語文 | 英文(English) |
中文摘要 | 自1992到1996,共3438例大腸鏡檢在臺大醫院外科部完成。大腸鏡檢完成率為84% 。共發現 570 例息肉,419 例癌症,其中 248 例(佔 25 %)腫瘤位於近端大腸,這是乙 狀結腸鏡檢無法到達的位置。 大便有潛血反應者,17 %可找到息肉,有 30 %可發現癌症 。接受息肉切除者共 391 例,僅一例併發急性出血。共 8 例發生大腸穿孔( 0.23 %), 5 例在穿孔後 24 小時內手術,全部存活。另 3 例在 24 小時後才手術,2 例死亡。 腸穿 孔的危險因子包括老年人, 接受過腹部手術者及憩室炎患者。 整體大腸鏡檢的合併症為 0.26 %,死亡率為 0.06 %。 腸穿孔預後取決於手術的時間而非手術的方式。對於能早期 診斷並立即手術的病例,直接初步縫合而無需大腸造�瓷A也可得到不錯的結果。 |
英文摘要 | From 1992 to 1996, 3438 cases of colonoscopy were performed with modern videoendoscopic equipment and advanced techniques at the Colorectal section, Department of Surgery, National Taiwan University Hospital. The examinations were done or supervised by experienced colonoscopists. The completion rate of colonoscopy was 84%. There were 570 polyps and 419 carcinoma. Among these cases, 248 cases (25%) were with tumors located at the proximal colon where the sigmoidoscopy cannot reach. In patients with positive fecal occult blood, 17% were noted to have adenoma and 30% had carcinoma. Polypectomy was performed in 391 cases, with only one case complicated with active bleeding. In diagnostic colonoscopy, perforation occurred in 8 patients (0.23%) and all these patients underwent surgical intervention. The risk for perforation included old age, previous abdominal operation and diverticulitis. Five patients underwent operation within 24 hours and all survived. Of the other 3 patients with treatment delayed for over 24 hours, one survived and the other two died. The overall morbidity rate was 0.26% and the mortality rate was 0.06%. We concluded that colonoscopy is a valuable and safe procedure. The outcome of an iatrogenic perforation is related to the time lag in surgical intervention. Early surgical intervention by primary closure without colostomy could give a satisfactory result to the patients with colon perforation caused by diagnostic colonoscopy. |
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