战争中的结直肠损伤的外科治疗
概括
战争造成的结肠直肠创伤,通常是枪击或弹片造成的,患病率很高. 现代外科手术倾向于在口腔上进行解肠切除,除了严重的病例外.
科学领域:
- 创伤外科 手术 创伤外科
- 军事医学 军事医学
- 结肠直肠手术 结肠直肠手术
背景情况:
- 结肠直肠创伤发生在5-10%的现代战争冲突中,主要来自枪击或弹片.
- 尽管有进展,但结直肠损伤的诊断和治疗延迟导致严重的发病率.
- 已建立的分级系统指导手术管理,包括结肠损伤量表,直肠损伤量表和弗林特分级系统.
研究的目的:
- 审查当前在战争中对结直肠创伤的手术管理策略.
- 为了强调最喜欢的外科手术技术和用于静脉造的指示.
- 突出更新的关于辅助程序的建议.
主要方法:
- 对当前关于手术治疗结直肠创伤的文献和临床指导方针的综述.
- 对损伤评估的评分方案 (结肠损伤量表,直肠损伤量表,石分级系统) 的分析.
- 讨论外科手术技术,包括用解剖切除与解剖切除相对立口形成.
主要成果:
- 首要或延迟解剖的结肠切除是首选的方法,没有增加治愈并发症的风险.
- 终端口腔只适用于血液动力学不稳定的患者,患有严重的出血或败血性休克和扩散性周周炎.
- 腹腔内直肠损伤的治疗方式与结肠损伤类似;腹腔外损伤的治疗方法可能是用经 sutures.
结论:
- 现代手术管理在结肠和腹腔内直肠损伤方面优先考虑解剖切除而不是口腔.
- 带有骨盆软组织参与的破坏性直肠损伤需要初始静脉口腔的创建与延迟的重建.
- 宫前排水和直肠茎洗不再是推的做法.
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