| 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. |
