外置修补术在结肠损伤中的应用

Application of exteriorizing repair in colon injuries

目的 探讨外置修补术在高危结肠损伤患者中替代结肠造口术的作用。方法 4 8例结肠损伤患者。按Flint法分级 :Ⅰ级 1 2例 ,Ⅱ级 1 9例 ,Ⅲ级 1 7例。一期修补术 2 1例 ,其中Ⅰ级全部 ,Ⅱ级 9例 ;4 8例中外置修补术 1 3例 ,其中Ⅱ级 5例 ,Ⅲ级 8例 ;结肠造口术 1 4例中 ,Ⅱ级 5例 ,Ⅲ级 9例。结果 2 1例一期修补术患者 ,切口感染 2例 (9.5 % ) ,吻合口瘘 2例 (9.5 % ) ,平均住院时间 1 1 .5天。 1 3例外置修补术患者 ,修补处裂开 3例 (2 3% ) ,切口感染 1例 (7.7% ) ,死亡 1例 (7.7% ) ,平均住院时间 2 0 .5天 (P <0 .0 5 )。 1 4例结肠造口术患者 ,切口感染 1例 (7.1 % ) ,造口还纳术后吻合口瘘 1例 (7.1 % ) ,死亡 1例 (7.1 % ) ,平均住院 31天。结论 对需结肠外置的高危肠损伤患者以外置修补术替代结肠造口术不增加手术并发症及病死率 ,且能缩短住院时间、节省住院费用。

Objective To investigate the effect of colon exteriorizing repair instead of colostomy for severe colon injuries.Methods 13 cases of colon injuries were treated with exteriorizing repair among 48 cases of colon injuries.According to Flint classification,12 cases were degree Ⅰ,19 were degree Ⅱ and 17 were degree Ⅲ.21 cases underwent primary repair,including 12 cases in degree I and 9 in degree Ⅱ; 13 cases underwent exteriorizing repair,including 5 cases in degree Ⅱ and 8 cases in degree Ⅲ; 14 underwent colostomy,including 5 cases in degree II and 9 cases in degree Ⅲ.Results There were 2 cases of incision infection(9.5%),and 2 cases of anastomosis leakage(9.5%),with an average hospitalizing time of 11.5 days,among 21 cases with primary repair.There were 3 cases of dehiscence in repair region(23%),and 1 case of incision infection(7.7%),with an average hospitalizing time of 20.5 days(P<0.01),among 13 cases with exteriorizing repair.There were 1 case of incision infection (7.1%) and 1 case of death(7.1%),with an average hospitalizing time of 31 days among 14 cases with colostomy.Conclusion Exteriorizing repair instead of colostomy for severe colon injuries will not increase operational complications and mortality and can shorten hospitalizing time,save hospitalizing fee and avoid suffering of returning stoma into the abdomen cavity.