创伤性结肠损伤的处理

Management of traumatic colon injury

探讨创伤性结肠损伤的诊断和处理方法 ,提高早期确诊率和治疗成功率 ,降低并发症和死亡率。方法 回顾性分析我院 1993～ 1998年期间 3 2例结肠损伤的临床资料。结果 早期确诊 2 4例 ( 75% ) ,误诊 8例 ( 2 5% )。 3 2例结肠损伤中行单纯结肠一期缝合修补 2 4例 ,一期结肠切除吻合 5例 ,共 2 9例 ,一期手术率 90 6%。损伤肠段修补或切除加近端造瘘 3例 ,造瘘率 9 4 %。并发症 4例 ,占 13 8% ;全组病例无死亡。结论 本组资料结果表明 ,大部份结肠损伤可采用一期修补或一期切除吻合术处理 ;而损伤早期容易误诊 。

Objective To study the diagnosis and management of traumatic colon injury, improve the efficiency of early diagnosis and treatment, and reduce complications and mortality. Methods The clinical data of 32 cases of colon injury from 1993 to 1998 were retrospectively analysed. Results Of 32 cases, 24(75%) were diagnosed early and 8(25%) were misdiagnosed. In addition, of 24 cases, simple one stage repair of colon and the one stage anastomosis after excision of injuried colon were performed making up 90.6% of the first stage operation rate, while the proximal colostomy plus repair or excision of injuried colon was done in 3 cases making up 9.4% of the colostomy rate. 4 cases(13.8%) had complications. No death occurred in this series. Conclusions These data suggest that the one stage repair or one stage anastomosis after excision should be recommended for most patients with colon injury, and that emphasis should be put on the early stage diagnosis of the injury, because of the misdiagnosis is easily made.