Aliev S A
Khirurgiia (Mosk). 2000(10):35-40.
The results of examination and surgical treatment of 108 patients (93 males, 15 females), aged from 19 to 73 years, with large intestine injuries of different origin are presented. Large intestine injuries as a result of stab-incised abdominal wounds was in 58 patients, gunshot wounds--in 29, blunt trauma--in 21. The diagnosis of large intestine injuries was based on clinico-laboratory, X-ray and instrumental examinations. The injury of blind intestine was revealed in 8 patients, ascending colon--in 11, transverse colon--in 39, descending colon--in 5, sigmoid colon--in 45. All the patients were operated. The method of choice in the surgical treatment of these injuries was suturing of damaged portion of large intestine, which was performed in 72 patients. In 14 patients the suturing was complemented by decompressive colostomy, in 3--by extraperitonisation of the damaged site, in 4--by extraperitonisation and decompressive colostomy, in 2--by terminal ileostomy. Resection of damaged intestinal segment with primary anastomosis was performed in 4 patients, right-side hemicolectomy--in 7, Hartmann's operation--in 17, resection of large intestine with bitrunk colostoma creation--in 3, transfer of damaged segment of large intestine--in 5. Repeated operations for intestine integrity repair and fistula closure were performed in 47 patients. 18 (16.7%) patients died after operation as a result of peritonitis (7), shock and acute hemorrhage (10), denutrition due to intestinal fistula (1).
本文介绍了108例年龄在19至73岁之间、患有不同病因大肠损伤患者的检查及手术治疗结果。其中男性93例,女性15例。因腹部刺伤导致的大肠损伤患者有58例,枪伤患者29例,钝性创伤患者21例。大肠损伤的诊断基于临床实验室检查、X线检查和器械检查。发现盲肠损伤8例,升结肠损伤11例,横结肠损伤39例,降结肠损伤5例,乙状结肠损伤45例。所有患者均接受了手术。这些损伤的手术治疗首选方法是缝合大肠受损部位,72例患者采用了该方法。14例患者在缝合的基础上进行了减压结肠造口术,3例患者对受损部位进行了腹膜外覆盖,4例患者同时进行了腹膜外覆盖和减压结肠造口术,2例患者进行了末端回肠造口术。4例患者进行了受损肠段切除并一期吻合,7例患者进行了右侧半结肠切除术,17例患者进行了哈特曼手术,3例患者进行了大肠切除并双腔结肠造口术,5例患者进行了大肠受损段移位术。47例患者因肠瘘进行了多次修复肠完整性和闭合瘘管的手术。18例(16.7%)患者术后因腹膜炎(7例)、休克和急性出血(10例)、肠瘘导致的营养不良(1例)死亡。