Curran T J, Borzotta A P
Legacy Emanuel Hospital and the Department of Surgery, Oregon Health Sciences University, Portland, USA.
Am J Surg. 1999 Jan;177(1):42-7. doi: 10.1016/s0002-9610(98)00293-1.
To evaluate the safety and efficacy of primary repair of colon injuries.
A literature review was made of 35 publications containing 5,400 colon injuries in retrospective and prospective studies.
There were 62 (2.4%) failures in 2,627 primary repairs based on surgeon discretion or absence of risk factors. In prospective series of 337 patients repaired without exclusionary criteria, there were 4 (1.2%) suture line failures (P = not significant). In prospective randomized trials without exclusionary criteria, 127 primary repairs had less morbidity compared with 109 diverted patients (P <0.02). The leak rate after resection and anastomosis (5.5%) is greater than after simple suture of perforation (1.4%; P <0.001). The 66 colon repair leaks were treated by conversion to colostomy or led to fistulae that usually healed spontaneously. A preponderance of failed repairs occurred in the setting of multiple injuries or comorbid conditions.
Penetrating and blunt colon injuries in civilian practice are safely managed by primary repair, but colostomy may still be advised in selected cases.
评估结肠损伤一期修复的安全性和有效性。
对35篇包含5400例结肠损伤的回顾性和前瞻性研究文献进行综述。
在2627例基于外科医生判断或无危险因素的一期修复中，有62例（2.4%）失败。在337例无排除标准的前瞻性修复患者系列中，有4例（1.2%）缝合线失败（P值无统计学意义）。在无排除标准的前瞻性随机试验中，127例一期修复的发病率低于109例改道患者（P<0.02）。切除吻合术后的渗漏率（5.5%）高于单纯穿孔缝合术后（1.4%；P<0.001）。66例结肠修复渗漏通过改行结肠造口术治疗，或导致瘘管形成，瘘管通常可自愈。修复失败多发生在多发伤或合并症的情况下。
在临床实践中，穿透性和钝性结肠损伤通过一期修复可安全处理，但在某些特定情况下仍可能建议行结肠造口术。
