结直肠损伤的手术治疗：附125例报告.pdfVIP

第l6卷第l2期 中国普通外科杂志 Vo1．16 No．12 2007年l2月 Chinese Journal of General Surgery Dec． 2007 文章编号：1005—6947(2007)12—1171—03 · 临床研究· 结直肠损伤的手术治疗：附1 25例报告 高劲谋，赵山红，林曦，曾剑波，何平，韦功滨 (重庆市急~t．rg疗中心创伤科，重庆400014) 摘要：目的 探讨结直肠损伤的手术治疗和围手术期处理。方法 回顾性分析19年间收治的 1 25例结直肠损伤患者的临床资料。结果 结肠和腹膜内直肠破裂69例中，初期缝合或切除吻合 56例(81．16％)，行造El术1 1例，“损伤控制外科”术式2例。腹膜外直肠破裂1 8例中，14例行乙状 结肠近端造El并骶前引流，4例一期修补未造El；其余38例非全层损伤患者，均做简单修补。全组死 亡8例(6．40％)，6例术中、1例术后死于失血性休克，1例术后5 d死于胸腔感染。术后并发症包括 局部感染6例、粘连性肠梗阻 1例，均治愈。结论 多数结肠和腹膜内直肠损伤可一期手术，应配合围 手术期正确使用抗生素尤其甲硝唑。腹膜外直肠伤应分期手术，为阻断远端污染，应行乙状结肠近端 造El而不选择襻式造El。 [中国普通外科杂志，2007，16(12)：1171—1173] 关键词：创伤和损伤／外科学；结肠／损伤；直肠／损伤 中图分类号：R 656 文献标识码：A Management of eoloreetal injuries：a report of 1 25 cases GAO Jin—ITIOU，ZHAO Shan—hong，LIN Xi，ZENG Jian—bo，HE Ping，WEI Gong—bin (Department of Traumatology，Chongqing Emergency Medial Center，Chongqing 400014，China) Abstract：Objective To evaluate operative and perioperative treatment for colorectal injuries．Methods The clinical data of 1 25 patients with colorectal injuries treated over a period of 1 9 years were retrospectively studied．Results In 6 9 patients with perforated colon or intraperitoneal segment of the rectum， 56(81．16％)were managed with primary repair or anastomosis，1 1 cases received a colostomy，and 2 cases had”Damage control surgery”．In the 1 8 patients with perforated extraperitoneal segm ent of the rectum．1 4 underwent diverting colostomy of the pmximal end of sigmoid with presacral drainage；4 cases，whose wound was small and contamination was mild，received primary repair without colostomy；and the other 3 8 cases without full·thickness lesions of the colon and rectum were treated by simple suture．The overall mortality rate w