Stanković N, Sćekić M, Janjić P, Mirković D, Cuk V
Vojnomedicinska akademija, Klinika za opstu i vaskularnu hirurgiju, Beograd.
Vojnosanit Pregl. 1997 Mar-Apr;54(2):103-7.
The treatment results of 35 wounded with rectal and perineal lesion, treated in the period from 1991 to 1993 were analyzed retrospectively. In military hospitals, 82% of wounded were primarily surgically managed. The majority (65.8%) was with injury of intraperitoneal rectal segment, 10 patients (28.5%) were with the lesion of extraperitoneal segment and 2 patients (5.7%) were with the injury of anal tract and perineum. The injuries were mostly inflected by the bullets of various calibers (42.6%). Multiple or combined injuries were found in 91.6% of wounded with rectal injury and 38.2% of them were managed within 6 hours after injury. Different surgical procedures, most frequently the lesion suture and proximal colostomy (n = 14) were primarily used. Postoperative complications occurred in 10 wounded (28.6%). In 3 wounded it was reintervened by Hartmann's procedure. Mortality rate was 8.5% (n = 3). Anorectal war injuries are the most severe of all the colonic injuries. To our experience and the unique war surgical doctrine in the primary treatment of rectum injury, the most important is to perform terminal colostomy, injury suture (always intraperitoneal, and extraperitoneal if possible, including the sphincter muscles approximation) and presacral drainage.
回顾性分析了1991年至1993年期间收治的35例直肠和会阴损伤伤员的治疗结果。在军队医院，82%的伤员首先接受了手术治疗。大多数（65.8%）为腹膜内直肠段损伤，10例（28.5%）为腹膜外段损伤，2例（5.7%）为肛管和会阴损伤。损伤大多由各种口径的子弹所致（42.6%）。91.6%的直肠损伤伤员存在多发伤或复合伤，其中38.2%在受伤后6小时内接受了治疗。主要采用了不同的手术方法，最常见的是损伤缝合和近端结肠造口术（n = 14）。10例伤员（28.6%）发生了术后并发症。3例伤员接受了哈特曼手术再次干预。死亡率为8.5%（n = 3）。肛肠战伤是所有结肠损伤中最严重的。根据我们的经验以及直肠损伤初期治疗中独特的战伤外科原则，最重要的是进行末端结肠造口术、损伤缝合（始终在腹膜内，如有可能也在腹膜外，包括括约肌肌肉对合）和骶前引流。
