1st Propedeutic Surgical Department, Aristotle's University of Thessaloniki, AHEPAT, Oikonomidi 21, 551 31 Kalamaria, Greece.
Tech Coloproctol. 2011 Oct;15 Suppl 1:S63-6. doi: 10.1007/s10151-011-0734-0.
Several factors have been considered important for the decision between diversion and primary repair in the surgical management of colorectal injuries. The aim of this study is to clarify whether patients with colorectal injuries need diversion or not.
From 2008 to 2010, ten patients with colorectal injuries were surgically treated by primary repair or by a staged repair.
The patients were five men and five women, with median age 40 years (20-55). Two men and two women had rectal injuries, while 6 patients had colon injuries. The mechanism of trauma in two patients was firearm injuries, in two patients was a stab injury, in four patients was a motor vehicle accident, in one woman was iatrogenic injury during vaginal delivery, and one case was the transanal foreign body insertion. Primary repair was possible in six patients, while diversion was necessary in four patients.
Primary repair should be attempted in the initial surgical management of all penetrating colon and intraperitoneal rectal injuries. Diversion of colonic injuries should only be considered if the colon tissue itself is inappropriate for repair due to severe edema or ischemia. The role of diversion in the management of unrepaired extraperitoneal rectal injuries and in cases with anal sphincter injuries is mandatory.
在结直肠损伤的外科治疗中，有几个因素被认为对分流与一期修复的决策很重要。本研究旨在阐明结直肠损伤患者是否需要分流。
2008 年至 2010 年，10 例结直肠损伤患者接受一期修复或分期修复。
患者 5 男 5 女，中位年龄 40 岁（20-55）。2 例男性和 2 例女性直肠损伤，6 例结肠损伤。2 例患者的创伤机制为火器伤，2 例为刺伤，4 例为机动车事故，1 例女性为分娩时医源性损伤，1 例为经肛门异物插入。6 例患者可行一期修复，4 例患者需要分流。
所有穿透性结肠和腹膜内直肠损伤的初始外科治疗都应尝试一期修复。只有当结肠组织因严重水肿或缺血而不适合修复时，才应考虑结肠损伤的分流。在未修复的腹膜外直肠损伤和伴有肛门括约肌损伤的情况下，分流的作用是强制性的。
