【作者】 王金海； 陈文斌； 叶锋； 徐向明； 林建江；

【Author】 WANG jinhai CHEN wenbin YE feng XU xiangming LIN jianjiang(Department of Colorectal Surgery, First Affiliated Hospital,College of Medicine,Zhejiang University, Hangzhou 310003,China)

【机构】 浙江大学医学院附属第一医院肛肠外科暨结直肠外科中心；

【摘要】 目的总结直肠肛管外伤诊治经验。方法回顾性分析浙江大学附属第一医院肛肠外科2001～2007年收治的39例直肠肛管外伤患者的资料,按腹膜返折上、下及肛提肌以下的肛门括约肌及周围皮肤损伤分类,对三类患者的人口统计学、致伤原因、临床表现、诊断治疗及随访分析进行统计学分析,总结规律及诊治经验。结果平均损伤严重度记分(ISS)19.4,总的手术率89.7%,漏诊率17.9%,愈合率84.6%。并发症发生率为25.6%,肛提肌以下的肛门括约肌及周围皮肤损伤并发症发生率较高,术后便失禁发生率最高。死亡2例,均为严重多发伤,死亡原因为多脏器功能衰竭。结论直肠肛管外伤患者可以选择性结肠造口,严重损伤、失活组织过多需清创后放置骶前引流,严重括约肌损伤无法修补或修补失败导致完全性便失禁治疗困难,可以考虑行回肠代阑尾的Monti手术予以前向性灌肠。更多还原

【Abstract】 Objective The aim of the study was designed to develop treatment algorithms for rectal and anal injuries based on the review of our institutional experience.Methods:The medical records of patients with rectal and anal injuries to First Affiliated Hospital, College of Medicine,Zhejiang University,over the last 6 years (2001 - 2007) were retrospectively reviewed.Data abstraction included patient demographics,mechanism of injury,injury severity score, associated injuries,presenting symptoms,methods of diagnosis, treatment and resultant complications.39 patients with rectal and anal injuries were identified.Result:The average injury severity score (ISS) was 19.4.Digital rectal examination was performed as a result of a positive diagnostic examination in 29(74.4%) patients, 27(69.2%)patients with penetrating or blunt injuries underwent laparotomy.Primary repair without a diverting colostomy was performed in 3 patients(2 intraperitoneal and 1 extraperitoneal injury) without complications.Total complication rate was 25.6%and rate of missed diagnosis was 17.9%.Conclusion The management of penetrating and blunt rectal and anal injuries has evolved during the past 10 years.primary repair or resection and anastomosis have found an increasing role in patients with nondestructive injuries.A critical review of recent literature better defines the role of primary repair and fecal diversion for these injuries and allows for better algorithms for the management of these injuries.更多还原