Performance of primary repair on colon injuries sustained from low-versus high-energy projectiles.
Performance of primary repair on colon injuries sustained from low-versus high-energy projectiles.
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DOI：
10.1016/j.jflm.2016.01.005
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发表时间：
2016-04
影响因子：
1.5
通讯作者：
Curovic I
中科院分区：
文献类型：
--
作者：
Lazovic R;Radojevic N;Curovic I
在各种原因中，结肠损伤可能由低能量或高能量火器子弹引起，后者产生暂时的空化现象。现有的治疗方案包括一期修复和两阶段管理，但最近的研究表明，一期修复可以广泛使用，成功率高。本文探讨了这两种类型的结肠损伤的一期修复性能的差异。根据子弹类型，回顾性地对两组因单发枪伤而导致结肠损伤的患者进行分类。在根据入选和排除标准（Stone和Fabian标准）选择的所有患者中进行了一期结肠修复术。在年龄、术前潜伏时间和四个创伤指数方面，各组之间达到了几乎绝对的同质性。低能量火器射弹组中只有1名患者（4%）发生了术后并发症，而高能量组中有9名患者（25.8%）发生了术后并发症，显示出统计学显著差异（p = 0.03）。这9名患者发生了以下术后并发症：肺炎、脓肿、瘘管、缝线渗漏和1例多器官衰竭伴败血症。以前的研究得出结论，一期一期修复是结肠损伤的最佳治疗选择。然而，终端弹道学测试确定了弹丸穿过人体的路径，并显示低能弹丸造成的损害比高能弹丸小得多。对于低能量的短火器伤，必须明确进行一期结肠修复术，但对于高能量的损伤，必须非常小心。鉴于这些发现，我们建议，治疗方案的确定不仅要根据子弹类型，而且还应根据其他临床表现。
Among various reasons, colon injuries may be caused by low- or high-energy firearm bullets, with the latter producing a temporary cavitation phenomenon. The available treatment options include primary repair and two-stage management, but recent studies have shown that primary repair can be widely used with a high success rate. This paper investigates the differences in performance of primary repair on these two types of colon injuries. Two groups of patients who sustained colon injuries due to single gunshot wounds, were retrospectively categorized based on the type of bullet. Primary colon repair was performed in all patients selected based on the inclusion and exclusion criteria (Stone and Fabian's criteria). An almost absolute homogeneity was attained among the groups in terms of age, latent time before surgery, and four trauma indexes. Only one patient from the low-energy firearm projectile group (4%) developed a postsurgical complication versus nine patients (25.8%) from the high-energy group, showing statistically significant difference (p = 0.03). These nine patients experienced the following postsurgical complications: pneumonia, abscess, fistula, suture leakage, and one multiorgan failure with sepsis. Previous studies concluded that one-stage primary repair is the best treatment option for colon injuries. However, terminal ballistics testing determined the projectile's path through the body and revealed that low-energy projectiles caused considerably lesser damage than their high-energy counterparts. Primary colon repair must be performed definitely for low-energy short firearm injuries but very carefully for high-energy injuries. Given these findings, we suggest that the treatment option should be determined based not only on the bullet type alone but also on other clinical findings.