General and Digestive Tract Department, Marina Baja Medical Center, Alcalde En Jaume Botella Mayor 7, 03570, Villajoyosa, Alicante, Spain.
General and Digestive Tract Department, Marina Baja Medical Center, Alcalde En Jaume Botella Mayor 7, 03570, Villajoyosa, Alicante, Spain .
World J Surg. 2012 May;36(5):1148-1153. doi: 10.1007/s00268-012-1513-4.
Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a safe and feasible procedure. We present our series of left colon resection and primary anastomosis procedures from Torrevieja Hospital (Alicante, Spain), performed without bowel irrigation or a diverting ileostomy.
Thirty-two RPA procedures were performed in emergency settings for perforation or obstruction, or both, during an 18-month period. The following data were prospectively collected: age, gender, nationality, diagnoses, ASA score, body mass index (BMI), POSSUM score (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), and the score according to the Hinchey classification. Furthermore, duration of the operation, length of postoperative hospital stay, and mortality and morbidity data were recorded.
Sixteen of these patients were diagnosed with acute diverticulitis, 14 patients with neoplasm (of which 9 cases had obstruction, 2 cases had perforation, and 3 cases had both), and foreign body perforation in the remaining 2 cases. The mean hospital stay was 7.8 (range, 4-10) days. The physiological POSSUM score was 24.4 (range, 15-39), and the surgical POSSUM score was 19.8 (range, 16-24). None of the patients died (0% mortality). Seven patients developed some kind of complication (21.9%), all of which were managed conservatively.
The results of this study suggest that RPA for left colon obstruction and perforation in emergency settings can be safely performed in certain surgical conditions.
对于急性护理外科医生来说，大肠梗阻和穿孔仍然是经常发生的疾病。在这些情况下，Hartmann 手术是最常用的手术技术。然而，最近的论文表明，在急诊环境下进行结肠切除和一期吻合术（RPA）是一种安全可行的手术。我们展示了我们在西班牙阿利坎特托雷维耶哈医院进行的左半结肠切除和一期吻合术系列，这些手术在没有肠道冲洗或转流性回肠造口术的情况下进行。
在 18 个月的时间里，我们对 32 例因穿孔或梗阻或两者同时发生而在急诊环境下进行的 RPA 手术进行了前瞻性研究。收集了以下数据：年龄、性别、国籍、诊断、ASA 评分、体重指数（BMI）、POSSUM 评分（生理和手术严重度评分用于死亡率和发病率的评估）和根据 Hinchey 分类的评分。此外，还记录了手术时间、术后住院时间以及死亡率和发病率数据。
这些患者中有 16 例被诊断为急性憩室炎，14 例为肿瘤（其中 9 例有梗阻，2 例有穿孔，3 例同时有梗阻和穿孔），还有 2 例为异物穿孔。平均住院时间为 7.8 天（范围为 4-10 天）。生理 POSSUM 评分为 24.4（范围为 15-39），手术 POSSUM 评分为 19.8（范围为 16-24）。没有患者死亡（死亡率为 0%）。有 7 名患者出现了某种并发症（21.9%），所有并发症均经保守治疗处理。
本研究结果表明，在某些手术条件下，RPA 可安全用于治疗左半结肠梗阻和穿孔。
