Thomson S R, Baker A, Baker L W
Department of Surgery, University of Natal Medical School, Durban, South Africa.
J R Coll Surg Edinb. 1996 Feb;41(1):20-4.
Solitary colon injuries are being increasingly managed by intraperitoneal primary closure. The optimal management of the colon wound in multiple injuries of the colon, which have a high mortality, has not been determined. From 1983-1989, 668 patients sustained colonic injuries. In 71 of these patients the colon was injured at more than one site. Of the 597 single injuries to the colon, 472 (79%) were due to stabs and 102 (17%) to gunshot wounds. Sixty-eight men and three women sustained injuries at more than one site in the large intestine. The median age of patients was 26 years (range 13-66). In 61 patients the colon was injured at two sites and in seven patients at three sites. Three patients had more than three sites injured. The injuries were inflicted by: gunshots 35 (49%); stabs, 30 (42%); shotguns, three; and blunt trauma, three. Forty-one patients were treated by intraperitoneal primary closure (IPC) and 30 by a colostomy procedure or exteriorization of the primarily sutured colon (EPSC). Penetrating Abdominal Trauma Index (PATI) scores were high at 32 +/- 6, and were similar for all methods of colon wound management. Twenty-four patients were suffering from shock on admission, 13 of those patients were treated by primary repair and 11 were treated by an exteriorization procedure. Individuals treated by an exteriorization procedure stayed in hospital significantly longer, 45 days versus 21 days (P < 0.004) and had a higher mortality rate, five deaths versus one death (P < 0.04) than those patients who were primarily repaired. Intraperitoneal primary closure of all wounds is the method of choice for the majority of multiple injuries. Colostomy procedures or EPSC contribute to morbidity and mortality.
孤立性结肠损伤越来越多地通过腹腔内一期缝合进行处理。对于死亡率较高的结肠多处损伤中结肠伤口的最佳处理方法尚未确定。1983年至1989年期间，668例患者遭受结肠损伤。其中71例患者的结肠在不止一个部位受伤。在597例结肠单处损伤中，472例（79%）为刺伤，102例（17%）为枪伤。68名男性和3名女性在大肠的不止一个部位受伤。患者的中位年龄为26岁（范围13 - 66岁）。61例患者的结肠在两个部位受伤，7例患者在三个部位受伤。3例患者有三个以上部位受伤。致伤原因如下：枪伤35例（49%）；刺伤30例（42%）；霰弹枪伤3例；钝性创伤3例。41例患者采用腹腔内一期缝合（IPC）治疗，30例采用结肠造口术或一期缝合结肠外置术（EPSC）治疗。穿透性腹部创伤指数（PATI）评分较高，为32±6，且所有结肠伤口处理方法的评分相似。24例患者入院时处于休克状态，其中13例患者接受一期修复治疗，11例患者接受外置术治疗。接受外置术治疗的患者住院时间明显更长，分别为45天和21天（P < 0.004），且死亡率更高，分别为5例死亡和1例死亡（P < 0.04），高于接受一期修复治疗的患者。对于大多数多处损伤，所有伤口的腹腔内一期缝合是首选方法。结肠造口术或EPSC会增加发病率和死亡率。
