CAJ | 학술논문

目的比较损伤控制手术(DCS)处理严重结肠损伤时,二期确定性手术肠切除肠吻合与肠造口两种结肠修补方式的安全性.方法回顾性分析2005-2013年间在中山大学附属第三医院接受DCS处理的67例严重结肠损伤患者的临床资料,按二次确定性手术中结肠修补方式,分为吻合组(40例,单纯肠缝合修补术,或肠切除肠吻合术)和造口组(27例,肠切除肠吻合加近端预防性肠造口),比较两组患者术后并发症发生情况,并对术后结肠吻合口瘘的危险因素进行分析.结果吻合组与造口组患者一般资料、损伤程度、入院时生理状态及初次手术处理(包括输血)的差异均无统计学意义(P＞0.05).确定性手术后,两组患者吻合口瘘、腹腔脓肿、肠外瘘及切口感染等并发症发生率的差异均无统计学意义(P＞0.05).吻合组和造口组分别有6例(15.0％)和3例(1 1.1％)患者出现结肠吻合口瘘(P＞0.05).在9例结肠吻合口瘘患者中有7例(7/9)出现左半结肠损伤,明显高于其在无吻合口瘘者中的比例(41.4％,24/58) (P＜0.05);腹膜关闭中位时间为10d,较无吻合口瘘患者(2 d)明显延迟(P＜0.05).结论在严重结肠损伤的DCS处理中,肠造口术不宜优先考虑;尽早关闭腹膜或有助于降低结肠吻合口瘘的发生概率.
목적 비교손상공제수술(DCS)처리엄중결장손상시,이기학정성수술장절제장문합여장조구량충결장수보방식적안전성.방법 회고성분석2005-2013년간재중산대학부속제삼의원접수DCS처리적67례엄중결장손상환자적림상자료,안이차학정성수술중결장수보방식,분위문합조(40례,단순장봉합수보술,혹장절제장문합술)화조구조(27례,장절제장문합가근단예방성장조구),비교량조환자술후병발증발생정황,병대술후결장문합구루적위험인소진행분석.결과 문합조여조구조환자일반자료、손상정도、입원시생리상태급초차수술처리(포괄수혈)적차이균무통계학의의(P＞0.05).학정성수술후,량조환자문합구루、복강농종、장외루급절구감염등병발증발생솔적차이균무통계학의의(P＞0.05).문합조화조구조분별유6례(15.0％)화3례(1 1.1％)환자출현결장문합구루(P＞0.05).재9례결장문합구루환자중유7례(7/9)출현좌반결장손상,명현고우기재무문합구루자중적비례(41.4％,24/58) (P＜0.05);복막관폐중위시간위10d,교무문합구루환자(2 d)명현연지(P＜0.05).결론 재엄중결장손상적DCS처리중,장조구술불의우선고필;진조관폐복막혹유조우강저결장문합구루적발생개솔.
Objective To compare the safety of anastomosis and ostomy following 2-stage definitive colonic resection when severe colonic injuries treated in the setting of damage control surgery (DCS).Methods Clinical data of 67 patients with severely traumatic colonic injuries undergoing DCS at the Third Affiliated Hospital of Sun Yat-sen University between 2005 and 2013 were analyzed retrospectively.Patients were divided into the anastomosis group undergoing colonic resection and anastomosis (n=40),and the ostomy group undergoing anastomosis with a protecting proximal ostomy (n=27).Postoperative complications were compared between these two groups.The risk factors of colonic anastomosis leakage were analyzed.Results Demographics,injury severity,physiological imbalance on admission,transfusion during the first operative procedure were similar in the two groups (all P ＞0.05).Rates of anastomotic leakage,intra-abdominal abscess,enterocutaneous fistula,and would infection after definitive resection were not statistically different between the two groups (all P＞ 0.05).Colonic anasomotic leakage rates were 15.0％(6/40) in anastomosis group and 11.1％(3/27) in ostomy group without significant difference (P＞0.05).Left-sided colon injuries occurred in 7 out of 9 patients with anatomotic leakage,whose proportion was significantly higher than that in those without anastomotic leakage(7/9 vs.24/58,77.8％ vs.41.4％,P＜0.05).A prolonged peritoneal closure was also observed in patients with anastomotic leakage (median,10 days vs.2 days,P＜0.05).Conclusions A strategy of diverting ostomy is not the first choice for patients sufering from severe colonic injuries in the setting of DCS.Peritoneal closure at early stage may decrease the risk of colonic anastomotic leakage.