Nallathambi M N, Ivatury R R, Rohman M, Stahl W M
J Trauma. 1987 Aug;27(8):876-82.
Eighty-five patients with penetrating colon injuries, treated either by exteriorized repair (39) or loop colostomy (46), were analyzed. Missile wounds accounted for 75.3% of the injuries. The Penetrating Abdominal Trauma Index (PATI) was the scoring method employed to assess quantitatively the severity of injuries in each patient. Of 21 patients with right colon injuries, eight were treated by exteriorized repair and the remainder by loop colostomy. PATI and other variables were comparable in both groups. Suture line leaks occurred in two patients (25%) with exteriorized repair. The morbidity was similar in both groups. In left colon trauma, exteriorized repair was employed in 31 patients and 33 underwent loop colostomy. The injury severity indices, clinical status, and time lapse to laparotomy were similar in both groups. Colostomy was avoided in 67.7% (21 of 31) patients with exteriorized repair. The incidence of abscesses was significantly higher in the colostomy group compared to the group treated by exteriorized repair (24.2% and 6.4%, respectively; p less than 0.05). The length of hospital stay was shorter after exteriorized repair (17.2 days vs. 23.2 days; p less than 0.05). All three mortalities (3.5%) were related to associated injuries. We conclude that exteriorized repair is a safe and superior alternative to loop colostomy in penetrating colon trauma.
对85例穿透性结肠损伤患者进行了分析，这些患者分别接受了外置修复术（39例）或袢式结肠造口术（46例）治疗。导弹伤占损伤的75.3%。采用穿透性腹部创伤指数（PATI）对每位患者的损伤严重程度进行定量评估。在21例右结肠损伤患者中，8例接受了外置修复术，其余患者接受了袢式结肠造口术。两组患者的PATI及其他变量具有可比性。接受外置修复术的2例患者（25%）出现缝线漏。两组的发病率相似。在左结肠创伤中，31例患者接受了外置修复术，33例接受了袢式结肠造口术。两组的损伤严重程度指数、临床状况及开腹手术时间间隔相似。接受外置修复术的患者中67.7%（31例中的21例）避免了结肠造口术。与外置修复术治疗组相比，结肠造口术组脓肿的发生率显著更高（分别为24.2%和6.4%；p<0.05）。外置修复术后住院时间更短（17.2天对23.2天；p<0.05）。所有3例死亡（3.5%）均与合并伤有关。我们得出结论，在外伤性结肠穿透伤中，外置修复术是一种安全且优于袢式结肠造口术的替代方法。
