腹膜外直肠损伤的处理
Management of extraperitoneal rectal injuries.
作者信息
Bostick P J, Johnson D A, Heard J F, Islas J T, Sims E H, Fleming A W, Sterling-Scott R P
机构信息
Martin Luther King, Jr/Drew Medical Center, Charles R. Drew University of Medicine and Science, Los Angeles, California.
出版信息
J Natl Med Assoc. 1993 Jun;85(6):460-3.
Twenty-eight consecutive extraperitoneal rectal injuries for a period of 34 months ending in May 1990 were reviewed retrospectively. All injuries were due to penetrating gunshot wounds. The rectal exam was positive in 75% of patients versus 80.8% with proctosigmoidoscopy. All 28 patients had diversion of the fecal stream. Diverting colostomies were performed in 17 patients, Hartmann's colostomies in 7 patients, and proximal loop colostomies in 4 patients. Presacral drainage was used in 25 patients (89.3%). Distal irrigation was performed in 13 patients (46.4%) and primary repair in 9 patients (32.1%). There was one infectious complication (3.6%) and no deaths (0%). Fecal diversion and presacral drainage are the mainstay of therapy for civilian rectal injuries. The importance of distal irrigation of the rectum has not been established. Primary repair of the rectum has no effect on morbidity and mortality.
回顾性分析了截至1990年5月的34个月内连续发生的28例腹膜外直肠损伤。所有损伤均由穿透性枪伤所致。直肠检查在75%的患者中呈阳性，而直肠乙状结肠镜检查的阳性率为80.8%。所有28例患者均进行了粪便转流。17例行转流性结肠造口术，7例行哈特曼结肠造口术，4例行近端袢式结肠造口术。25例患者（89.3%）采用了骶前引流。13例患者（46.4%）进行了远端冲洗，9例患者（32.1%）进行了一期修复。有1例感染并发症（3.6%），无死亡病例（0%）。粪便转流和骶前引流是治疗平民直肠损伤的主要方法。直肠远端冲洗的重要性尚未确立。直肠一期修复对发病率和死亡率无影响。
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