Roche B, Michel J M, Deléaval J, Peter R, Marti M C
Policlinique de Chirurgie, Hôpitaux Universitaire de Genève.
Swiss Surg. 1998(5):249-52.
Injuries of the colon and rectum are common surgical problems. Lesions can be classified into four groups according to the site of damage and the presence of sphincter tears: 1. intraperitoneal perforation without sphincter damage 2. intraperitoneal perforation with sphincter damage 3. extraperitoneal perforation without sphincter damage 4. extraperitoneal perforation with sphincter damage From 1990 to 1998, 11 patients, 7 males and 4 females presenting an anal and/or rectal trauma were admitted in Geneva University Hospital. 8 patients were admitted as an emergency, the 3 others had been transferred to correct an incontinent post traumatic pathology. No mortality. A terminal colostomy was performed in all patients with intraperitoneal injury and in 5 patients with combined extraperitoneal and anal sphincter injury. All sphincter lesions were sutured as an emergency (6 cases). In 3 patients we performed an overlapping sphincteroplasty. 2 patients with persisting incontinence were cured by a dynamic stimulated graciloplasty. The choice of treatment of anorectal trauma includes broad spectrum antibiotherapy, cleaning of the rectum, sphincter repair. A terminal diverting colostomy and laparotomy must be achieved in case of intraperitoneal injury, large extraperitoneal lesion, severe perineal laceration with or without pelvic fracture.
结肠和直肠损伤是常见的外科问题。根据损伤部位和括约肌撕裂情况，病变可分为四组：1. 无括约肌损伤的腹膜内穿孔；2. 有括约肌损伤的腹膜内穿孔；3. 无括约肌损伤的腹膜外穿孔；4. 有括约肌损伤的腹膜外穿孔。1990年至1998年，日内瓦大学医院收治了11例肛门和/或直肠创伤患者，其中男性7例，女性4例。8例为急诊入院，另外3例因创伤后失禁问题转入本院治疗。无死亡病例。所有腹膜内损伤患者以及5例腹膜外和肛门括约肌联合损伤患者均行了末端结肠造口术。所有括约肌损伤均在急诊时进行了缝合（6例）。3例患者接受了重叠式括约肌成形术。2例持续性失禁患者通过动态刺激股薄肌成形术治愈。肛管直肠创伤的治疗选择包括广谱抗生素治疗、直肠清洁、括约肌修复。对于腹膜内损伤、较大的腹膜外病变、伴有或不伴有骨盆骨折的严重会阴撕裂伤，必须进行末端转流结肠造口术和剖腹手术。
