Richon J, Agoritsas A, Petropoulos P, Hahnloser P
Helv Chir Acta. 1989 Jan;55(5):659-62.
Resection and primary anastomosis (RPA) in emergency left-side colon surgery is not universally performed because of anastomotic healing difficulties of unprepared, dilated, or inflamed colons. Ninety-three patients underwent emergency surgery for left-side colon disease. Sixty-three primary anastomoses were performed with a 16% mortality rate and a 6% incidence of anastomotic leakage. These results are similar to those reported in the literature, depending upon the pathology involved, and appear to justify resection and primary anastomosis in case of hemorrhage, trauma, and left-colonic obstruction. As for diverticular perforation with localized peritonitis, RPA can be attempted in some instances, if a protective stoma is added. Finally, in case of diffuse peritonitis, the Hartmann procedure still remains the safest method.
由于未准备好的、扩张的或发炎的结肠吻合口愈合困难,急诊左侧结肠手术中并不普遍进行切除及一期吻合术(RPA)。93例患者因左侧结肠疾病接受了急诊手术。其中63例进行了一期吻合,死亡率为16%,吻合口漏发生率为6%。这些结果与文献报道的结果相似,具体取决于所涉及的病理情况,并且似乎证明在出血、创伤和左结肠梗阻的情况下进行切除及一期吻合是合理的。至于伴有局限性腹膜炎的憩室穿孔,如果加做保护性造口,在某些情况下可以尝试进行RPA。最后,在弥漫性腹膜炎的情况下,Hartmann手术仍然是最安全的方法。