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穿透性创伤中小肠和大肠联合损伤的损伤控制性外科处理：造口术仍然相关吗？

Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?

机构信息

Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.

Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.

出版信息

Colomb Med (Cali). 2021 Apr 27;52(2):e4114425. doi: 10.25100/cm.v52i2.4425.

DOI:10.25100/cm.v52i2.4425
PMID:34188327
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8216049/
Abstract

Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.

摘要

中空脏器损伤在穿透性创伤中所导致的整体损伤中占很大比例。目前，在接受确定性剖腹手术的患者中，孤立的小肠或大肠损伤通常通过一期吻合术进行治疗，而在需要损伤控制性手术的患者中则进行延期吻合术。传统的肠造口术的外科教条已被证明是不必要的，而且在许多情况下实际上会增加发病率。本文的目的是阐述在处理穿透性创伤患者的合并中空脏器损伤方面所获得的经验。我们试图确定在合并小肠和大肠穿透性损伤的患者中，通过吻合术进行一期和/或延期肠损伤修复是否是首选的手术方法。我们的经验表明，超过 90%的所有合并穿透性肠损伤可以通过一期或延期吻合术进行治疗，即使是在最严重的需要应用损伤控制性原则的情况下也是如此。通过应用这种策略，造口术（一期或延期）的总体需求可以降低到不到 10%。

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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ae1/8216049/721ea66c0a07/1657-9534-cm-52-02-e4114425-gf7.jpg
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