結腸直腸外傷

從民國71年7月至78年6月，高雄醫學院外科共經驗有64例結腸直腸外傷的病例。男48例，女16例。年齡14至90歲，平均43.6±17.6歲。其中34例（53.1%）為貫穿傷，30例（46.9%）為鈍挫傷。26例（86.7%）的鈍挫傷合併其他臟器傷害，顯著地較貫穿傷（7例，20.6%）常見且較多合併傷害，而以小腸的合併傷害最多。以Flint等（6）的結腸外傷等級來評估傷害嚴重度，顯示鈍挫傷明顯地較貫穿傷嚴重，但和受傷部位則無關。依嚴重等級和術者的判斷，42例施行結腸造口術，14例初期縫合，2例切除再吻合及6例做縫合創口並將之外置。初期縫合的病例中無死亡者，但2例經發現縫合不全再開腹行結腸造口術。縫合創口並將之外置者有50%（3例）縫線裂開而形同結腸造口，但無其他合併症。29例（45.3%）發生合併症，以傷口感染及腹部膿瘍最常見，9例（14.1%）死亡。分析危險因素，顯示合併症和死亡率與傷害嚴重度及受傷原因有關，但和受傷的部位無關。結論：（1）於特別選擇，情況良好的病例施行初期縫合是行的（2）結腸直腸外傷的預後結果取決於受傷原因及傷害嚴重程度而非受傷的部位。

關鍵字

無資料

並列摘要

From July 1982 to June 1989, 64 patients with trauma involving a colon and rectum operated on at the Kaohsiung Medical College Hospital were retrospectively reviewed. Their ages ranged from 14 to 90 years (mean 43.6±17.6 years); were male, 16female. Thirty-four (53.1%) had penetrating injuries, 30 (46.9%) had blunt injuries, Twenty-six (86.7%) blunt injuries and (20.6%) penetrating injuries involved various associated injuries. There was a significantly greater number of associated organ injury in cases of blunt trauma. The most common organ injured concomitantly was the small intestine. The severity of injury and general condition were quantified for each patient using the intraoperative grading system proposed by Flint et al(6), and revealed that it was independent of the colorectal site, but related to the mode of trauma. After an assessment of the grade of injury, 42 patients underwent colostomies, 14 primary closues, 2 resections and anastomoses and 6 exteriorized repairs In the primary closure group, there was no mortality but 2 suture leakages which reoperated to colostomies. In three patients (50%) of the exteriorized repair group with fecal leakage developed at the repair site, the exteriorized loops were coverted into colostomies without complication. The most common complications were wound infection and abdominal abscess. The mortality (14.1%) and morbidity (45.3%) were not related to the location of the injured bowel but were influenced by the grade of colorectal trauma, associated organ injury and the mode of trauma. In conclusion, our data suggest that (1) primary closure for colorectal wounds in selected cases is a safe procedure (2) the outcome of the colorectal traumas depends upon the severity and mode of trauma but not the severity and mode of trauma but not the location.

並列關鍵字

colon ； rectum ； trauma

國際替代計量

結腸直腸外傷

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