美国创伤外科协会 I 级和 II 级结肠损伤的一期修复与切除术：处理方式真的重要吗？一项东部创伤外科学会多中心试验。

Primary repair versus resection for American Association for the Surgery of Trauma grades I and II colon injuries: Does the management approach really matter? An Eastern Association for the Surgery of Trauma multicenter trial.

作者信息

Fitzgerald Caitlin A, Barnes Christopher, Bisgaard Erika K, McLafferty Bryant J, Harrell Kevin N, Fleming Matthew M, Meizoso Jonathan P, Walker James, Sciarretta Jason D, Succar Bahaa E, Cheng Mingyuan, Lewis Richard H, Davis Greggory R, Puli Odessa, Egodage Tanya, Mooney Jennifer, Nguyen Stacy, Kirsch Jordan M, Jose Anna Mary, Lumbard Derek, Finn Andreana, Sheppard Kyle, Shively Korey S, Butts Caleb, Lasinski Alaina M, Beattie Nicholas G, Noory Mary N, Chaudhary Sejul A, Irish William, Leung Pak, Luketic Karla, Noorbakhsh Matthew, Almahmoud Khalid, Cash Alison, Bernard Andrew C, Kumar Arathi, DeSantis Anthony J, Kozar Rosemary A, Prasad Ajay, Siletz Anaar E, Schroeppel Thomas J, Rodriquez Jennifer, Tackett Nichole, Mentzer Caleb, Sabu-Kurian Anna, Bankhead Brittany K, Bhattacharya Bishwajit, Maung Adrian A, Chang Grace, Ramoutar Uma, Farrell Michael S, Hamdan Marah, Wong Yee M, Deci Ryan T, Fernandez Luis, Pero Brandi, Palacio Carlos H, Rendon Garcia Juan J, Myall James J, Riggle Andrew J, Golestani Simin, Dilday Joshua, Miller April, Taveras Luis, Grande Payton, Scott Stephanie, Dumas Ryan P

机构信息

From the Department of Surgery, Division of Trauma and Acute Care Surgery, East Carolina University (C.A.F., M.N.N., S.A.C., W.I.), Greenville, North Carolina; Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington Harborview Medical Center (C. Barnes, E.K.B.), Seattle, Washington; Department of Surgery, Division of Trauma, Acute Care, and Critical Care Surgery, Tulane University (B.J.M., K.N.H.), New Orleans, Louisiana; Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, University of Miami Jackson Memorial Hospital Ryder Trauma Center (M.M.F., J.P.M.), Miami, Florida; Department of Surgery, Grady Memorial Hospital (J.W., J.D.S.), Atlanta, Georgia; Department of Surgery, Division of Trauma, Burn, Acute, and Critical Care Surgery, University of Texas Southwestern (B.E.S., M.C., R.P.D.), Dallas, Texas; Department of Surgery, Our Lady of the Lake Regional Medical Center/LSU HSC Baton Rouge (R.H.L., G.R.D.), Baton Rouge, Louisiana; Department of Surgery, Cooper University Hospital (O.P., T.E.), Camden, New Jersey; Department of Surgery, Baylor Scott and White Dallas (J.M., S.N.), Dallas, Texas; Department of Surgery, Section of Trauma and Acute Care Surgery, Westchester Medical Center (J.M.K., A.M.J.), Valhalla, New York; Department of Surgery, Division of Trauma and Critical Care, Hennepin Healthcare Research Institute (D.L., A.F.), Minneapolis, Minnesota; Department of Surgery, Division of Trauma and Surgical Critical Care, University of South Alabama (K.S., K.S.S., C. Butts), Mobile, Alabama; Department of Surgery, MetroHealth (A.M.L., N.G.B.), Cleveland, Ohio; Department of Surgery, Division of Trauma and Critical Care, Jefferson Einstein Philadelphia Hospital (P.L., K.L.), Philadelphia, Pennsylvania; Department of Surgery, Division of Trauma and Acute Care Surgery, Allegheny General Hospital (M.N., K.A.), Allegheny, Pennsylvania; Department of Surgery, Division of Acute Care Surgery, Trauma, and Surgical Critical Care, University of Kentucky (A.C., A.C.B.), Lexington, Kentucky; Department of Surgery, Division of Trauma Surgery, Santa Clara Valley Medical Center (A.K.), Santa Clara, California; Department of Surgery, Program in Trauma, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center (A.J.D., R.A.K.), Baltimore, Maryland; Department of Surgery, Division of Trauma and Surgical Critical Care, University of Southern California (A.P., A.E.S.), Los Angeles, California; Department of Surgery, Division of Trauma and Acute Care Surgery, UC Health Memorial Hospital (T.J.S., J.R.), Colorado Springs, Colorado; Department of Surgery, Division of Trauma and Critical Care, Spartanburg Medical Center (N.T., C.M.), Spartanburg, South Carolina; Department of Surgery, Division of Trauma and Surgical Critical Care, Texas Tech University Health Science Center (A.S.-K.), Lubbock, Texas; Department of Surgery, Division of General, Acute Care, Trauma, and Burn Surgery, Medical University of South Carolina (B.K.B.), Charleston, South Carolina; Department of Surgery, Division of General Surgery, Trauma, and Surgical Critical Care, Yale University (B.B., A.A.M.), New Haven, Connecticut; Department of Surgery, Division of Trauma Surgery, Mount Sinai Hospital Chicago (G.C., U.R.), Chicago, Illinois; Department of Surgery, Lehigh Valley Health Network (M.S.F., M.H.), Lehigh Valley, Pennsylvania; Department of Surgery, Division of Trauma, Wright State University Boonshoft School of Medicine/Miami Valley Hospital (M.H., Y.M.W., R.T.D.), Dayton, Ohio; Department of Surgery, Division of Trauma Surgery, University of Texas Health East Texas (L.F., B.P.), Tyler; Department of Surgery, Division of Trauma and Critical Care, South Texas Health System (C.H.P., J.J.R.G.), McAllen, Texas; Department of Surgery, Gundersen Health System (J.J.M., A.J.R.), La Crosse; Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin (S.G., J.D.), Milwaukee, Wisconsin; Department of Surgery, Medical City Plano (A.M., L.T.), Plano, Texas; and Department of Surgery, Division of Trauma and Critical Care Surgery, University of Tennessee Knoxville (P.G., S.S.), Knoxville, Tennessee.

出版信息

J Trauma Acute Care Surg. 2025 Jul 1;99(1):105-112. doi: 10.1097/TA.0000000000004649. Epub 2025 Jun 6.

DOI:10.1097/TA.0000000000004649

PMID:40474346

Abstract

BACKGROUND

The management of traumatic low-grade (American Association for the Surgery of Trauma [AAST] grades I and II) colon injuries has evolved. Recent data suggest that primary repair (PR) or resection over colostomy decreases morbidity and mortality. However, data comparing patients undergoing PR versus resection with anastomosis (RWA) are lacking. We hypothesized that patients presenting with low-grade colon injuries undergoing PR would have fewer postoperative complications than patients undergoing RWA.

METHODS

This was a retrospective, multicenter analysis of all patients presenting with AAST grades I and II colon injuries to 32 Level 1 trauma centers from 2011 to 2021. Based on operative documentation, patients were dichotomized into two groups, those who underwent PR or RWA. Outcomes included length of stay, infectious complications, and mortality. Multivariate logistic regression was performed to determine the independent effect of operative technique on outcomes.

RESULTS

A total of 2,022 patients met the inclusion criteria for this study. Most were young (36 [24-44] years), male (79.6%), and presented after penetrating trauma (58.2%). A total of 1,013 patients presented with a grade I injury, while 1,009 patients presented with a grade II injury. Furthermore, 1,314 patients underwent PR, and 708 underwent RWA. While there was no difference in Injury Severity Score between PR and RWA, RWA was associated with more adverse outcomes including surgical site infections, suture line failure/leak, fascial dehiscence, and a longer hospital length of stay (all p < 0.001). When controlling for mechanism of injury, AAST grade, Injury Severity Score, and number of intra-abdominal injuries RWA were independently associated with more infectious complications including superficial, deep, and organ space surgical site infections.

CONCLUSION

Resection with anastomosis was independently associated with more adverse outcomes including multiple infectious complications and longer hospital length of stay compared with PR, suggesting that low-grade colon injuries can be safely managed with PR alone.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.

摘要

背景

创伤性轻度（美国创伤外科学会[AAST] I级和II级）结肠损伤的管理方法已经有所发展。近期数据表明，一期修复（PR）或切除而非结肠造口术可降低发病率和死亡率。然而，缺乏比较接受PR与切除吻合术（RWA）患者的数据。我们假设，与接受RWA的患者相比，接受PR的轻度结肠损伤患者术后并发症更少。

方法

这是一项对2011年至2021年期间32家一级创伤中心收治的所有AAST I级和II级结肠损伤患者进行的回顾性多中心分析。根据手术记录，将患者分为两组，即接受PR或RWA的患者。结局指标包括住院时间、感染性并发症和死亡率。进行多因素逻辑回归分析以确定手术技术对结局的独立影响。

结果

共有2022例患者符合本研究的纳入标准。大多数患者为年轻人（36[24 - 44]岁），男性（79.6%），且为穿透性创伤后就诊（58.2%）。共有1013例患者为I级损伤，1009例患者为II级损伤。此外，1314例患者接受了PR，708例患者接受了RWA。虽然PR组和RWA组的损伤严重程度评分无差异，但RWA与更多不良结局相关，包括手术部位感染、缝线失败/渗漏、筋膜裂开以及更长的住院时间（所有p<0.001）。在控制损伤机制、AAST分级、损伤严重程度评分和腹内损伤数量后，RWA与更多感染性并发症独立相关，包括浅表、深部和器官间隙手术部位感染。