Beiler H A, Zachariou Z, Daum R
Department of Pediatric Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
J Pediatr Surg. 1998 Aug;33(8):1287-91. doi: 10.1016/s0022-3468(98)90170-1.
BACKGROUND/PURPOSE: Because of the small numbers of impalement and anorectal injuries in childhood, a standardized therapeutic approach is necessary to avoid major complications. On the basis of a retrospective analysis of 12 children with such injuries treated from 1986 to 1996 in our department, the authors tried to establish guidelines for their treatment.
Additional therapeutic problems and main complications are elucidated after meticulous analysis of three selected cases.
In two cases of anorectal impalement and a primary colostomy, no complications occurred. However, in three cases involving anorectal injury a primary fecal diversion was not performed, making a secondary colostomy necessary afterwound infection.
The current standard principles in the treatment of severe anorectal injuries in children are fecal diversion, wound drainage, and broad spectrum antibiotics. A primary reconstruction in cases of impalement can be recommended only after exclusion of anorectal injury.
背景/目的：由于儿童刺伤和肛肠损伤的病例数量较少，因此需要一种标准化的治疗方法以避免出现严重并发症。基于对1986年至1996年在我科接受治疗的12例此类损伤患儿的回顾性分析，作者试图制定其治疗指南。
在对3例选定病例进行细致分析后，阐明了其他治疗问题和主要并发症。
在2例肛肠刺伤并一期行结肠造口术的病例中，未发生并发症。然而，在3例涉及肛肠损伤的病例中，未进行一期粪便转流，伤口感染后需行二期结肠造口术。
目前儿童严重肛肠损伤的治疗标准原则是粪便转流、伤口引流和使用广谱抗生素。仅在排除肛肠损伤后，才可建议对刺伤病例进行一期修复。
