一项关于结肠穿透伤的十年研究。

A ten-year study of penetrating injuries of the colon.

作者信息

Adesanya Adedoyin A, Ekanem Ekanem E

机构信息

Department of Surgery, Lagos University Teaching Hospital and College of Medicine, University of Lagos, Lagos, Nigeria.

出版信息

Dis Colon Rectum. 2004 Dec;47(12):2169-77. doi: 10.1007/s10350-004-0726-5.

DOI:10.1007/s10350-004-0726-5

PMID:15657670

Abstract

BACKGROUND

Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries.

PATIENTS AND METHODS

Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied.

RESULTS

Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury-related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure-related morbidity was 21 percent and mortality was 5.3 percent.

CONCLUSION

A more liberal use of primary repair is required in our patients with penetrating injuries of the colon.

摘要

背景

结肠损伤与脓毒症并发症及死亡率的高风险相关。我们前瞻性地研究了遭受穿透性结肠损伤患者的损伤模式、处理方法、结局及预后因素。

患者与方法

研究了1992年至2001年十年间我院收治的60例穿透性结肠损伤患者。

结果

55例（91.7%）患者的结肠伤口由枪伤所致，5例（8.3%）由刀刺伤所致。30例（50%）患者在剖腹手术前延迟超过12小时。58例（96.7%）患者腹腔出现中度或重度粪便污染。穿透性腹部创伤指数平均评分为25.9，20例（33.3%）患者为弗林特3级结肠损伤。相关的腹内损伤发生于小肠（73.3%）、肝脏（25%）、胃（23.3%）和肠系膜（16.7%）。右半结肠伤口（35处），24例（68.6%）患者行一期修复，11例（31.4%）患者行近端转流性结肠造口术；而左半结肠伤口（25处），22例（88.0%）患者行转流性结肠造口术，3例（12.0%）患者行一期修复。常见并发症包括伤口感染（56.7%）、败血症（31.7%）和肠皮肤瘘（16.7%）。总死亡率为33.3%，与结肠损伤相关的死亡率为21.7%。存在结肠毁损性损伤与死亡发生率增加四倍以上相关。其他重要的危险因素包括入院时休克、重度粪便污染、手术时间超过4小时、穿透性腹部创伤指数评分>25以及术后出现两种以上并发症。一期修复患者与行转流性结肠造口术患者的结局无差异。结肠造口关闭相关的发病率为21%，死亡率为5.3%。