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[结肠损伤:313例患者的治疗研究]

[Colon injuries: treatment study in 313 patients].

作者信息

Nahas S C

机构信息

Serviço de Emergência, Faculdade de Medicina, Universidade de São Paulo.

出版信息

Rev Hosp Clin Fac Med Sao Paulo. 1993 Sep-Oct;48(5):214-9.

PMID:8165406
Abstract

The author presents a retrospective descriptive study of 313 colon injuries treated surgically. The lesions were caused by fire arms and knife wounds, impalement and closed abdominal trauma. Results were analysed considering factors directly involved with the outcome in terms of morbidity and mortality. They were age, sex, ethnic group, span of time between traumatic event and surgery, type and anatomical location of colonic lesions and associated injuries, degree of contamination of the abdominal cavity, surgical procedure, intraabdominal and surgical wound, post-operative complications, systemic complications, evolution and results of post-mortem examinations in cases of death. The results of observations can be summarized as follows: 1. Mortality rate was 10.22% (32 patients). 2. The majority of cases with lethal outcome (90.62% or 29 patients) had severe associated or missed injuries, pulmonary embolism and anesthetic complication. 3. There was a 43.75% (14 patients) mortality rate during the first 48 hours. 4. Mortality due directly to poor performance of the surgical procedure was found to be lower than 1%. 5. Primary closure of colon wounds was performed in 60.70% of cases and no deaths could be attributed to this procedure. 6. Different types of colostomy were performed in 109 patients (34.82%). In this group 94.5% of the cases had no complications. 7. Morbidity (31.4%) was mostly consequent to surgical wound complications (16.30%).

摘要

作者对313例接受手术治疗的结肠损伤进行了回顾性描述性研究。这些损伤由火器伤、刀伤、穿刺伤和闭合性腹部创伤引起。根据与发病率和死亡率结果直接相关的因素对结果进行了分析。这些因素包括年龄、性别、种族、创伤事件与手术之间的时间跨度、结肠损伤的类型和解剖位置、相关损伤、腹腔污染程度、手术方式、腹腔和手术切口、术后并发症、全身并发症、死亡病例的尸检结果及转归。观察结果总结如下:1. 死亡率为10.22%(32例患者)。2. 大多数致死病例(90.62%或29例患者)伴有严重的相关损伤或漏诊损伤、肺栓塞和麻醉并发症。3. 在最初48小时内死亡率为43.75%(14例患者)。4. 直接因手术操作不佳导致的死亡率低于1%。5. 60.70%的病例对结肠伤口进行了一期缝合,且无死亡病例归因于此操作。6. 109例患者(34.82%)进行了不同类型的结肠造口术。该组中94.5%的病例无并发症。7. 发病率为31.4%,主要是手术切口并发症所致(16.30%)。

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