Gygi C, Petropoulos P, Zimmerli W
Service de chirurgie, Hôpital cantonal, Fribourg.
Helv Chir Acta. 1993 Jun;59(5-6):735-7.
From 1976 to 1988, 123 emergency left colon procedures were carried out. 79 were single-step procedures, 34 were two-step and 10 were three-step. The presence or not of peritonitis was not systematically taken into consideration for procedure choice. Two of the 79 single-step patients presented an anastomosis leakage repair. Three of seven patients with postoperative peritonitis required reoperation for abscess formation. These figures are not significantly higher than those encountered in the two- or three-step procedure groups. As it was, one of these patients required a reintervention for fistula excision, as well as upper stomy trouble. In summary, we can say that emergency left colon resection with anastomosis without protective stomy is preferable with associated adequate antibiotherapy.
1976年至1988年期间,共进行了123例急诊左半结肠手术。其中79例为单步手术,34例为两步手术,10例为三步手术。在选择手术方式时,未系统考虑是否存在腹膜炎。79例单步手术患者中有2例进行了吻合口漏修补。7例术后发生腹膜炎的患者中有3例因脓肿形成需要再次手术。这些数字并不显著高于两步或三步手术组。事实上,其中1例患者需要再次手术切除瘘管以及处理高位造口问题。总之,我们可以说,在联合适当抗生素治疗的情况下,急诊左半结肠切除并吻合而不做保护性造口是更可取的。