转流性结肠造瘘在骨盆骨折合并会阴部损伤中的应用

 目的 总结转流性结肠造瘘在骨盆骨折合并会阴部损伤中的应用效果。方法 2005年 4 月至 2011年 4月, 治疗 27例骨盆骨折合并会阴部损伤患者, 男 23例, 女 4例;年龄 16~62岁, 平均 32.9岁;交通伤 19例, 高处坠落伤 4例, 挤压伤 2例, 重物砸伤 2例。骨盆骨折按 Tile分型: A型 4例, B 型 10例, C型 13例。采用骨盆外固定支架固定, 稳定血流动力学, 选择性应用转流性结肠造瘘及骨折复 位固定术进行治疗。应用 Fisher精确概率法对早期(伤后48h内)和非早期(损伤超过 48h或未造瘘) 行转流性结肠造瘘术患者的感染率进行比较。结果 24例患者存活, 3例死亡, 死亡率为 11%。存活的 24例患者均获得随访, 随访时间 4~42个月, 平均 10.9个月。 13例早期行结肠造瘘患者均未发生感染。 11例非早期行结肠造瘘患者中, 4例发生感染。早期行转流性结肠造瘘术患者的感染率显著低于非早 期患者, 两者比较差异有统计学意义。结论 骨盆骨折合并会阴部损伤早期急救重点为稳定血流动力学、选择性应用转流性结肠造瘘及早期骨盆固定。对于累及直肠、肛管的会阴部损伤或虽不累及直肠、 肛管但软组织损伤广泛的会阴部损伤均应行转流性结肠造瘘术。伤后 48h内行转流性结肠造瘘, 不但可有效降低感染率, 而且对保持患者良好营养状态、节省医疗开支及降低医护人员工作量有重要意义。

Fecal diversion in the management of pelvic fractures associated with perineal injuries

Objective To investigate fecal diversion in the management of pelvic fractures associated with perineal injuries.Methods This retrospective study involved 27 patients of pelvic fractures associated with perineal injuries during April 2005 to April 2011.There were 23 males and 4 females,and the mean age was 32.9 years old (range,16-62 years old).Fractures type according to Tile classification:4 cases were type A,10 cases were type B,and 13 cases were type C.The pelvic external fixator and fecal diversion were selectively used.Results Of the 27 patients of pelvic fractures associated with perineal injuries,24survived.The overall mortality of pelvic fractures associated with perineal injuries in the present study was 11％.The survived 24 patients were totally reviewed clinically.The mean follow-up time of these patients was 10.9 months (range,4-42 months).Of those patients who underwent early fecal diversion (＜ 48 h),none experienced infectious completions.However,of those underwent non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion),four patients experienced infectious completions.Fisher's exact test was used to compare the infection rate of these two groups.And the result of Fisher's exact test demonstrated that those patients who underwent early (＜ 48 h) fecal diversion and non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion).Conclusion Stabilization of hemodynamic; selective fecal diversion; early stabilization of pelvic fracture are necessary for the emergency management of pelvic fractures associated with perineal injuries.Rectal injury and severe perineal injury without involvement of rectum should undergo fecal diversion.Early fecal diversion (＜ 48 h) could reduce the infection rate of pelvic fractures associated with perineal injuries.