结肠创伤的一期缝合

Salinas-Aragón Luis Enrique, Guevara-Torres Lorenzo, Vaca-Pérez Enrique, Belmares-Taboada Jaime Arístides, Ortiz-Castillo Fátima de Guadalupe, Sánchez-Aguilar Martín

Departamento de Cirugía, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, San Luis Potosí, México.

Cir Cir. 2009 Sep-Oct;77(5):359-64.

BACKGROUND

Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality.

METHODS

This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis.

RESULTS

There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury.

CONCLUSIONS

Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

背景

结肠损伤的一期修复是一种被认可的治疗选择；然而，其安全性仍存在争议。我们的目的是报告接受一期缝合的结肠损伤患者并发症的演变及发生情况，并确定时间间隔（>6小时）、损伤程度、污染情况、损伤的解剖部位、穿透性腹部创伤指数（PATI）>25以及结肠创伤中其他损伤的存在是否与发病率和死亡率增加相关。

方法

这是一项前瞻性、观察性、纵向和描述性研究，于2003年1月1日至2007年12月31日在墨西哥圣路易斯波托西的“伊格纳西奥·莫罗内斯·普列托博士”中央医院进行。我们纳入了接受手术治疗的腹部创伤合并结肠损伤的患者。采用卡方检验进行基本统计分析。

结果

481例腹部创伤患者接受了手术；77例（16.1%）有结肠损伤。90%（n = 69）在最初6小时内接受治疗；91%（n = 70）为穿透伤，枪伤占48%（n = 37）。横结肠是最常受伤的部位（38%）（n = 29）。Ⅰ级和Ⅱ级损伤占75.3%（n = 58）。手术方式包括一期修复（76.66%）（n = 46）；切除吻合术（8.3%）（n = 5）；以及结肠造口术（15%）（n = 9）。76.6%（n = 59）存在合并伤。85.7%（n = 6）有一定程度的污染；82.8%（58）的PATI<25。28.57%（n = 22）观察到与手术相关的并发症。10%（n = 8）需要再次手术。平均住院时间为11.4天。死亡率为3.8%（n = 3）；这些均与结肠损伤无关。