Murray J A, Demetriades D, Colson M, Song Z, Velmahos G C, Cornwell E E, Asensio J A, Belzberg H, Berne T V
Department of Surgery, University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, USA.
J Trauma. 1999 Feb;46(2):250-4. doi: 10.1097/00005373-199902000-00009.
The management of colonic trauma is well established for simple injuries with primary repair, and ileocolostomy for right-sided injuries that undergo colonic resection. Segmental colon resection for injuries to the left colon can be managed with either an end colostomy or primary anastomosis. A retrospective review was performed to evaluate the outcome and complications associated with colonic resection for trauma to determine the risk factors associated with anastomotic leakage.
A retrospective review included patients undergoing colonic resection for trauma. The patients were stratified into colostomy, ileocolostomy, and colocolostomy groups. Patient demographics and colon-related complications were collected. Comparison between the colostomy and colocolostomy groups was performed to determine the difference in outcome. The outcome of right-sided colon injuries managed by either an ileocolonic or colocolonic anastomosis was compared. Analysis was performed to identify the factors associated with an increased risk of anastomotic leakage.
One hundred forty patients over a 66-month period were included in the analysis. Overall, 41% (57 of 140) of patients developed a colon-related complication; 28% (39 of 140) of patients developed an abscess. Overall, the anastomotic leak rate was 13% (7 of 56) in the colocolostomy group, 4% (2 of 56) in the ileocolostomy group. Right-sided colon injuries managed with a colocolonic anastomosis had a higher incidence of anastomotic leakage than ileocolonic anastomosis, i.e., 14 versus 4% respectively. Of the seven patients who developed a leak from a colocolonic anastomosis, two patients died (29%). Univariate analysis identified an Abdominal Trauma Index Score > or = 25 (p = 0.03) or hypotension in the emergency department (p = 0.001) to be associated with increased risk of developing an anastomotic leak from a colocolonic anastomosis.
Colonic injuries that are managed with resection are associated with a high complication rate regardless of whether an anastomosis or colostomy is performed. Colonic resection and anastomosis can be performed safely in the majority of patients with severe colonic injury, including injuries to the left colon. For injuries of the right colon, an ileocolostomy has a lower incidence of leakage than a colocolonic anastomosis. For injuries to the left colon, there remains a role for colostomy specifically in the subgroups of patients with a high ATI or hypotension, because these patients are at greater risk for an anastomotic leak. The role of resection and primary anastomosis versus colostomy in colonic trauma requires further investigation.
对于单纯性结肠损伤行一期修复，以及右侧结肠损伤行结肠切除术后行回结肠造口术，结肠创伤的处理方法已确立。左半结肠损伤行节段性结肠切除可采用端式结肠造口术或一期吻合术。进行了一项回顾性研究，以评估结肠切除治疗创伤的结果和并发症，确定与吻合口漏相关的危险因素。
一项回顾性研究纳入了因创伤行结肠切除的患者。患者被分为结肠造口术组、回结肠造口术组和结肠结肠吻合术组。收集患者人口统计学资料和与结肠相关的并发症。对结肠造口术组和结肠结肠吻合术组进行比较，以确定结果差异。比较右侧结肠损伤采用回结肠吻合术或结肠结肠吻合术的结果。进行分析以确定与吻合口漏风险增加相关的因素。
在66个月期间，140例患者纳入分析。总体而言，41%（140例中的57例）患者发生了与结肠相关的并发症；28%（140例中的39例）患者发生了脓肿。总体而言，结肠结肠吻合术组的吻合口漏率为13%（56例中的7例），回结肠造口术组为4%（56例中的2例）。右侧结肠损伤采用结肠结肠吻合术的吻合口漏发生率高于回结肠吻合术，分别为14%和4%。在7例结肠结肠吻合口漏的患者中，2例死亡（29%）。单因素分析确定腹部创伤指数评分≥25（p = 0.03）或急诊科低血压（p = 0.001）与结肠结肠吻合口漏发生风险增加相关。
无论进行吻合术还是结肠造口术，切除治疗的结肠损伤均与高并发症发生率相关。在大多数严重结肠损伤患者中，包括左半结肠损伤患者，结肠切除和吻合术可安全进行。对于右半结肠损伤，回结肠造口术的漏发生率低于结肠结肠吻合术。对于左半结肠损伤，结肠造口术在腹部创伤指数高或低血压的患者亚组中仍有作用，因为这些患者吻合口漏的风险更高。结肠创伤中切除和一期吻合术与结肠造口术的作用需要进一步研究。
