From the Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Trauma Acute Care Surg. 2024 Oct 1;97(4):497-504. doi: 10.1097/TA.0000000000004352. Epub 2024 Apr 10.
Colorectal injuries are commonly encountered by trauma surgeons. The management of colorectal injuries has evolved significantly over the past several decades, beginning with wartime experience and subsequently refining with prospective randomized studies. Colon injuries were initially nonoperative, evolved toward fecal diversion for all, and then became anatomic based with resection and primary anastomosis with selective diversion, and now primary repair, resection with primary anastomosis, and delayed anastomosis after damage-control laparotomy are all commonplace. Rectal injuries were also initially considered nonoperative until diversion came into favor. Diversion in addition to direct repair, presacral drain placement, and distal rectal washout became the criterion standard for extraperitoneal rectal injuries until drainage and washout fell out of favor. Despite a large body of evidence, there remains a debate on the optimal management of some colorectal injuries. This article will focus on how to diagnose and manage colorectal injuries. The aim of this review is to provide an evidence-based summary of the contemporary diagnosis and management of colorectal injuries.
创伤外科医生经常会遇到结肠直肠损伤。过去几十年中，结肠直肠损伤的处理方式发生了重大变化，从战时经验开始，随后通过前瞻性随机研究进行了改进。结肠损伤最初是非手术治疗，后来发展为所有患者都进行粪便转流，然后基于解剖学进行治疗，采用切除和一期吻合术，选择性转流，现在普遍采用一期修复、切除和一期吻合术，以及损伤控制性剖腹术后的延迟吻合术。直肠损伤最初也被认为是非手术治疗，直到转流术开始流行。转流术加上直接修复、骶前引流管放置和直肠远端冲洗成为腹膜外直肠损伤的标准治疗方法，直到引流和冲洗术不再流行。尽管有大量证据，但对于某些结肠直肠损伤的最佳处理方式仍存在争议。本文将重点介绍如何诊断和处理结肠直肠损伤。本综述的目的是提供关于结肠直肠损伤的当代诊断和处理的循证总结。
