Skube Mariya E, Mallery Quinn, Lusczek Elizabeth, Elterman Joel, Spott Mary A, Beilman Greg J
Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN.
Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH.
Mil Med. 2018 Sep 1;183(9-10):e454-e459. doi: 10.1093/milmed/usy009.
Although there are multiple studies regarding the management and outcomes of colonic injuries incurred in combat, the literature is limited with regard to small bowel injuries. This study seeks to provide the largest reported review of the characteristics of combat-associated small bowel injuries.
The Department of Defense Trauma Registry was queried for U.S. Armed Forces members who sustained hollow viscus injuries in the years 2007-2012 during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Concomitant injuries, procedures, and complications were delineated. Fisher's exact test was used to analyze the relationship of bowel injury pattern to rates of repeat laparotomy, fecal diversion, and complications.
One hundred seventy-one service members had small bowel injuries. The mean age was 25.8 ± 6.6 yr with a mean injury severity score of 27.9 ± 12.4. The majority of injuries were penetrating (94.2%, n = 161) as a result of explosive devices (61.4%, n = 105). The median blood transfusion requirement in the first 24 h was 6.0 units (interquartile range 1.0-17.3 units). The most frequent concomitant injuries were large bowel (64.3%, n = 110), pelvic fracture (35.7%, n = 61), and perineal (26.3%, n = 45). Fifty patients (29.2%) had a colostomy, and nine patients (5.3%) had an ileostomy; 62.6% (n = 107) of soldiers underwent more than one laparotomy. The mortality rate was 1.8% (n = 3). The most common complications were pneumonia (15.2%, n = 26), deep vein thrombosis (14.6%, n = 25), and wound infection (14.6%, n = 25). The need for repeat laparotomy and fecal diversion was found to be significantly associated with injury pattern (p = 0.00052 and p < 0.0001, respectively).
We found that two-thirds of service members with small bowel injuries also had a large bowel injury. One-third of the patients required diversion and two-thirds had more than one laparotomy. The pattern of bowel injury significantly affected the need for repeat laparotomy and fecal diversion.
尽管有多项关于战斗中结肠损伤的处理及结果的研究，但关于小肠损伤的文献却很有限。本研究旨在对与战斗相关的小肠损伤特征进行迄今最大规模的报道性综述。
查询国防部创伤登记处，获取2007年至2012年期间在持久自由行动、伊拉克自由行动和新黎明行动中遭受中空脏器损伤的美国武装部队成员信息。明确伴随损伤、手术及并发症情况。采用Fisher精确检验分析肠损伤类型与再次剖腹手术率、粪便转流率及并发症之间的关系。
171名军人有小肠损伤。平均年龄为25.8±6.6岁，平均损伤严重程度评分为27.9±12.4。大多数损伤为穿透伤（94.2%，n = 161），由爆炸装置导致（61.4%，n = 105）。最初24小时内的中位输血量为6.0单位（四分位间距1.0 - 17.3单位）。最常见的伴随损伤为大肠损伤（64.3%，n = 110）、骨盆骨折（35.7%，n = 61）和会阴损伤（26.3%，n = 45）。50例患者（29.2%）行了结肠造口术，9例患者（5.3%）行了回肠造口术；62.6%（n = 107）的士兵接受了不止一次剖腹手术。死亡率为1.8%（n = 3）。最常见的并发症为肺炎（15.2%，n = 26）、深静脉血栓形成（14.6%，n = 25）和伤口感染（14.6%，n = 25）。发现再次剖腹手术需求和粪便转流需求与损伤类型显著相关（分别为p = 0.00052和p < 0.0001）。
我们发现，三分之二有小肠损伤的军人同时伴有大肠损伤。三分之一的患者需要进行转流，三分之二的患者接受了不止一次剖腹手术。肠损伤类型显著影响再次剖腹手术需求和粪便转流需求。
