Levine J H, Longo W E, Pruitt C, Mazuski J E, Shapiro M J, Durham R M
Department of Surgery, St. Louis University Medical Center 63110-0250, USA.
Am J Surg. 1996 Nov;172(5):575-8; discussion 578-9. doi: 10.1016/S0002-9610(96)00244-9.
Diversion of the fecal stream with or without primary repair has been the mainstay of therapy for rectal injuries. Because primary repair has replaced colostomy as the treatment of choice for most colon injuries, we reviewed our experience with primary repair of rectal injuries in order to determine if primary repair without diversion is a feasible option in selected patients.
All traumatic rectal injuries over the past 48 months were reviewed for mechanism of injury, diagnosis, treatment, and outcome.
Thirty consecutive patients with extraperitoneal rectal injuries were identified. Six of the 30 patients underwent primary repair without diversion. Five were repaired transanally, and 1 was repaired at celiotomy. There was no morbidity related to the rectal repair in patients who underwent primary repair without diversion, and there were no deaths.
Based on a small number of patients, these data suggest that primary repair of rectal injuries in selected patients may be feasible. Further prospective investigation is needed to determine which patients may be successfully treated in this fashion.
粪便转流（伴或不伴一期修复）一直是直肠损伤治疗的主要方法。由于一期修复已取代结肠造口术成为大多数结肠损伤的首选治疗方法，我们回顾了我们对直肠损伤一期修复的经验，以确定在特定患者中不进行粪便转流的一期修复是否是一种可行的选择。
回顾过去48个月内所有创伤性直肠损伤患者的损伤机制、诊断、治疗及预后情况。
共确定30例连续性腹膜外直肠损伤患者。30例患者中有6例未进行粪便转流而直接进行了一期修复。5例经肛门修复，1例经剖腹手术修复。未进行粪便转流而直接进行一期修复的患者中，直肠修复未出现并发症，也无死亡病例。
基于少数患者的数据表明，在特定患者中对直肠损伤进行一期修复可能是可行的。需要进一步的前瞻性研究来确定哪些患者可以通过这种方式成功治疗。
