Jacobson L E, Gomez G A, Broadie T A
Department of Surgery, Indiana University School of Medicine and Indiana University/Wishard Trauma Center, Indianapolis 46202, USA.
Am Surg. 1997 Feb;63(2):170-7.
Although primary repair of penetrating colon injuries in patients with low injury severity is now widely accepted, several "risk factors" continue to be viewed as relative contraindications to this method of management. The purpose of this study was to evaluate the septic complications and leak rate in a series of consecutive penetrating colon injuries managed exclusively with primary repair. The records of 58 consecutive patients with penetrating intra-abdominal colon injuries managed at an urban Level I trauma center from July 1991 to December 1995 were reviewed. Patients were stratified for injury severity using the Penetrating Abdominal Trauma Index (PATI), and the presence of "risk factors" and septic abdominal and wound complications were recorded. All 58 patients were managed with primary repair. There were 48 gunshot wounds (72%), 7 shotgun wounds (12%), and 9 stab wounds (16%) with a mean PATI of 26.7 +/- 15.2 standard deviation. Seven patients (12.1%) developed intra-abdominal abscess, and all were managed by CT-guided percutaneous drainage. Five patients (8.6%) developed bacteremia, and eight patients (13.8%) developed fascial dehiscence. Three patients (5.2%) underwent abdominal re-exploration in the postoperative period, but none of these was related to failure of the colonic repair. There were no clinically apparent leaks or fistulae and no deaths. The presence of "risk factors" appeared to identify more severely injured patients as indicated by a higher mean PATI score and a higher incidence of intra-abdominal abscess, when compared to patients in whom the "risk factor" was absent. Primary repair can safely be used for virtually all penetrating colon injuries, as clinical leaks are rare, even in patients with "risk factors". Intra-abdominal abscess and other septic complications are dependent on the overall severity of the intra-abdominal injuries and probably result from contamination occurring at the time of injury rather than from postoperative leak from the primary repair.
尽管目前对于损伤严重程度较低的患者，穿透性结肠损伤的一期修复已被广泛接受，但仍有几个“危险因素”被视为这种治疗方法的相对禁忌证。本研究的目的是评估一系列仅采用一期修复治疗的连续性穿透性结肠损伤患者的感染并发症和漏出率。回顾了1991年7月至1995年12月在一家城市一级创伤中心接受治疗的58例连续性穿透性腹腔内结肠损伤患者的记录。使用穿透性腹部创伤指数（PATI）对患者的损伤严重程度进行分层，并记录“危险因素”的存在情况以及腹部感染和伤口并发症。所有58例患者均接受一期修复治疗。有48例枪伤（72%）、7例霰弹枪伤（12%）和9例刺伤（16%），平均PATI为26.7±15.2标准差。7例患者（12.1%）发生腹腔内脓肿，均通过CT引导下经皮引流治疗。5例患者（8.6%）发生菌血症，8例患者（13.8%）发生筋膜裂开。3例患者（5.2%）在术后接受了再次剖腹探查，但均与结肠修复失败无关。没有明显的临床漏出或瘘管形成，也没有死亡病例。与不存在“危险因素”的患者相比，“危险因素”的存在似乎表明患者损伤更严重，表现为平均PATI评分更高以及腹腔内脓肿发生率更高。一期修复实际上可安全用于所有穿透性结肠损伤，因为即使在有“危险因素”的患者中，临床漏出也很少见。腹腔内脓肿和其他感染并发症取决于腹腔内损伤的总体严重程度，可能是由损伤时的污染引起，而非一期修复术后的漏出。
