The Incidence And Treatment Status Of Perforation Of Adult Colonoscopic Perforation In The Top Three Hospitals Of Hengyang City

Objective: To analyze the occurrence and treatment status of colonoscopic perforation(CP)caused by the operation of adult colonoscopy in Hengyang City.Method: To collect relevant clinical data of CP patients in all tertiary hospitals in Hengyang City from May 1,2012 to April 30,2017,including basic patient information,purpose of colonoscopy,location of perforation,diagnosis and treatment time,and diagnosis Based on the specific treatment plan(see the appendix for the survey form),use Excel to establish a database,use SPSS20.0 software to perform statistical analysis on the data,and use Fisher's exact test and chi-square test to analyze the occurrence of diagnostic CP and therapeutic CP.The differences of relevant factors and the differences in the distribution of different sexes and perforation sites were analyzed.The differences in the choice of treatment methods between diagnostic CP and therapeutic CP and the differences in the choice of treatment time,the size of perforation,and the choice of treatment were analyzed.Result: All the three grade hospitals in Hengyang City were surveyed,and there were 4 hospitals that met the criteria for inclusion.They were all Grade III A hospitals.A total of 72,593 colonoscopy were performed,including 62,774 diagnostic colonoscopy and 9,819 therapeutic colonoscopy.Twenty-three(0.03%)cases of perforation were identified in relation to electronic colonoscopy,with 12 and 11 men and women,respectively.There are 5 persons under the age of 50,16 persons aged 50-75,and 2 persons over 75.Among the 23 cases of perforation,there were 6 cases of diagnostic CP(perforation rate 0.01%;1 case per 10462 cases)and 17 cases of therapeutic CP(perforation rate was 0.17%;approximately 1 per 578 cases).Of the 6 cases with diagnostic CP,4 occurred in the sigmoid colon(66.6%),1 occurred in the straight B junction(16.7%),and 1 occurred in the descending colon(16.7%).A total of 17 cases of therapeutic CP occurred in 1 case(5.9%)of ascending colon,8 cases(47.1%)of transverse colon(including colon spleen),5 cases of descending colon(29.4%),and 3 cases of sigmoid colon(17.6%).Among 23 CP patients,one conservative treatment(4.3%),two endoscopic treatments(8.7%),laparotomy(18.8%),and laparoscopic surgery(8.7%).Twenty patients(45%)had undergone perforation repair in 20 patients undergoing surgical treatment of CP,5(25%)had partial bowel resection,and 6(30%)had colostomy.One person under conservative treatment,2 under endoscopic treatment,2 under laparoscopic treatment,and 18 underwent open surgery.All patients were discharged and the mortality rate was 0.There was no significant difference in the distribution of different sexes and perforation sites(P>0.05).The incidence of diagnostic CP and therapeutic CP was not statistically different in gender,age,and duration of diagnosis(P>0.05).The incidence of diagnostic CP and therapeutic CP in the perforation site,the diameter of the perforation was statistically significant(P <0.05).There was no significant difference in the choice of therapeutic methods between diagnostic CP and therapeutic CP(P>0.05).There was no significant difference in the choice of treatment method between the time from diagnosis to treatment time and the size of perforation(P>0.05).Conclusion:1.The incidence of CP in Hengyang City was 0.03%,the incidence of diagnostic CP was 0.01%,and the incidence of therapeutic CP was 0.17%.2.Different sexes differ in the distribution of the perforation of the colonoscope.3.There was no significant difference in the occurrence of diagnostic CP and therapeutic CP between gender,age,and duration of diagnosis.4.There is a difference in the size of perforation and perforation site between diagnostic CP and therapeutic CP.The therapeutic perforation diameter of CP was more than 1cm,and the perforation site of therapeutic CP was more common in transverse colon and descending colon,while the perforation site of diagnostic CP was more common in sigmoid colon.5.There is no difference in the choice of treatment methods between diagnostic CP and therapeutic CP.There is no difference in the choice of treatment methods between CP patients with different diagnosis to treatment time and diameter of perforation,and the treatment is mainly based on open surgery in Hengyang City.