Shannon F L, Moore E E
Surgery. 1985 Oct;98(4):851-60.
Management of civilian colon injuries has clearly departed from the military directive advocating mandatory colostomy. The treatment of 228 colon injuries at the Denver General Hospital was reviewed to elucidate risk factors for colon-related complications and quantify the morbidity of available surgical treatment options. In our population, 68% of patients sustained gunshot wounds with a high percentage of severe colon injuries and associated abdominal organ damage. Primary repair was accomplished in 49% with 17% septic morbidity and 1% septic mortality rates. Colostomy was required in 36% with a cumulative septic morbidity of 48% and 2% septic mortality. The most common complications were abdominal abscess (12%), wound infection (7%), and fecal fistula (4%). Analysis of risk factors for colon-related morbidity showed that the Abdominal Trauma Index (ATI), colon injury severity, preoperative shock, and peritoneal contamination were most important. Synthesis of the treatment outcome and risk factor data yields a proposed management scheme for colon injuries that is based on the patient's hemodynamic status, colon injury severity, and ATI scores. Primary repair by either debridement and simple closure or resection with primary anastomosis is advocated for colon injuries in patients who are hemodynamically stable with an ATI score less than 25.
平民结肠损伤的处理方式显然已背离了主张强制进行结肠造口术的军事指导原则。回顾了丹佛总医院对228例结肠损伤的治疗情况，以阐明结肠相关并发症的危险因素，并量化现有手术治疗方案的发病率。在我们的患者群体中，68%的患者遭受枪伤，严重结肠损伤及相关腹部器官损伤的比例很高。49%的患者进行了一期修复，脓毒症发病率为17%，脓毒症死亡率为1%。36%的患者需要进行结肠造口术，累积脓毒症发病率为48%，脓毒症死亡率为2%。最常见的并发症是腹腔脓肿（12%）、伤口感染（7%）和粪瘘（4%）。对结肠相关发病危险因素的分析表明，腹部创伤指数（ATI）、结肠损伤严重程度、术前休克和腹腔污染最为重要。综合治疗结果和危险因素数据，得出了一种基于患者血流动力学状态、结肠损伤严重程度和ATI评分的结肠损伤建议处理方案。对于血流动力学稳定、ATI评分低于25的结肠损伤患者，主张通过清创并简单缝合或切除并一期吻合进行一期修复。
