Guivarc'h M, Marquand J, Chiche B, Mouchet A
J Chir (Paris). 1975 Mar;109(3):281-92.
When operating as an emergency for a perforation of the colon should one carry out a by-pass operation, colostomy or restore intestinal continuity? 36 colonic perforations are reported here, as a complication of cancer in 50 p. 100 of cases, or sigmoiditis in 38 p. 100 of cases. The perforation was situated on the sigmoid in 77 p. 100 of cases. 13 by-pass operations were carried out with a 23 p. 100 mortality, 12 colectomies without anastomosis with a 50 p. 100 mortality, and 2 colectomies with restoration of continuity, 9 p. 100 mortality. The overall mortality was 27.7 p. 100 much less than reported by other authors but, nevertheless partly due to the severity of peritonitis due to the presence of feces and, partly due to the operation adopted. The present attitude of the authors depends on the merits of each case. A large incision is made and the peritoneum thoroughly cleaned. If the surgeon is experienced, colonic resection is advisable for perforated cnacer and certain cases of sigmoiditis. Restoration of continuity depends, above all, on the anatomical condition of the colon above the lesion. Hartmann's resections or by-pass operations thus still have indications.
当因结肠穿孔进行急诊手术时，应该进行旁路手术、结肠造口术还是恢复肠道连续性？本文报告了36例结肠穿孔病例，其中50%是癌症的并发症，38%是乙状结肠炎的并发症。77%的穿孔位于乙状结肠。进行了13例旁路手术，死亡率为23%；12例不进行吻合的结肠切除术，死亡率为50%；2例恢复连续性的结肠切除术，死亡率为9%。总体死亡率为27.7%，远低于其他作者的报告，但部分是由于粪便导致的腹膜炎严重程度，部分是由于所采用的手术方式。作者目前的态度取决于每个病例的具体情况。做一个大切口，彻底清洁腹膜。如果外科医生经验丰富，对于穿孔性癌症和某些乙状结肠炎病例，建议进行结肠切除术。恢复肠道连续性首先取决于病变上方结肠的解剖状况。因此，哈特曼切除术或旁路手术仍有其适应证。
