O'Donnell Mary T, Greer Lauren T, Nelson Jeffery, Shriver Craig, Vertrees Amy
Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
Mil Med. 2014 Jul;179(7):778-82. doi: 10.7205/MILMED-D-13-00533.
Management of rectal injuries in war-injured patients has evolved over time.
Retrospective review of records of patients sustaining war-related rectal injuries admitted to Walter Reed Army Medical Center from Iraq and Afghanistan.
From 2003 to 2011, 67 males ages 18 to 40 sustained rectal injuries after secondary blast (64%), gunshot (33%), motor vehicle crash (1%), or helicopter crash (1%). Injuries were extraperitoneal (72%), intraperitoneal (25%), or both (3%). Rectal abbreviated injury score mean was 3 ± 1. Surgical management included end colostomy (66%), loop colostomy (28%), and no diversion (4%). Distal washout (24%) and drain placement (33%) were performed. Colostomy closure occurred in 79% of patients at an average of 237 days after injury.
Diversion is the preferred treatment of war-related rectal injuries. Loop colostomy is acceptable unless there is potential for evolving rectal injury. Routine use of presacral irrigation and drainage was not supported.
战争伤员直肠损伤的处理方法随着时间推移不断演变。
回顾性分析在沃尔特·里德陆军医疗中心收治的来自伊拉克和阿富汗的战争相关直肠损伤患者的记录。
2003年至2011年，67名年龄在18至40岁的男性在遭受二次爆炸（64%）、枪伤（33%）、机动车碰撞（1%）或直升机坠毁（1%）后出现直肠损伤。损伤为腹膜外（72%）、腹腔内（25%）或两者皆有（3%）。直肠简化损伤评分平均为3±1。手术处理包括末端结肠造口术（66%）、袢式结肠造口术（28%）和未行转流术（4%）。进行了远端冲洗（24%）和引流管放置（33%）。79%的患者在受伤后平均237天进行了结肠造口关闭术。
转流术是战争相关直肠损伤的首选治疗方法。除非存在直肠损伤进展的可能性，袢式结肠造口术是可以接受的。不支持常规使用骶前冲洗和引流。
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