Ridgeway C A, Frame S B, Rice J C, Timberlake G A, McSwain N E, Kerstein M D
Department of General Surgery, University of Kansas, Kansas City.
Dis Colon Rectum. 1989 Dec;32(12):1046-9. doi: 10.1007/BF02553879.
The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty-five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty-eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty-two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3 +/- 2.8 days and for colostomy patients, 25.7 +/- 3.8 days, counting days for both initial and colostomy closure admissions (P less than .05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.
回顾了81例连续性结肠穿透伤患者的病历。65例患者被纳入评估。对穿透性腹部创伤指数、合并伤、手术时间、致伤物、住院时间、治疗方法及感染并发症进行了评估。28例患者在损伤部位行结肠造口术：5例在修复近端行转流性结肠造口术，30例行一期修复（单处或多处损伤），2例行肠外置术及早期还纳。65例患者中总体感染发病率为15例（23%）。结肠造口术组33例中有9例（27%）发生感染，一期修复组30例中有6例（20%）发生感染，两组发病率差异无统计学意义。2例行肠外置修复术的患者未发生感染。65例研究患者中无死亡报告。33例结肠造口术中32例（97%）随后关闭，32例中有7例（22%）发生感染。一期修复患者的平均住院时间为10.3±2.8天，结肠造口术患者为25.7±3.8天，计算初次住院及结肠造口关闭住院的天数（P<0.05）。结肠造口术并非由结肠损伤的解剖位置、数量、肠壁受累周径、粪便污染情况或肠系膜血供受累情况决定。本研究表明，一期修复不会增加感染并发症的风险，且为患者避免了结肠造口关闭的重大风险及住院时间延长。建议针对该领域开展前瞻性研究。
