急诊结直肠疾病的剖腹手术从战场创新到现代实践。

IF 0.7 Q3 EMERGENCY MEDICINE
Journal of Emergencies, Trauma, and Shock Pub Date : 2025-07-01 Epub Date: 2025-07-29 DOI:10.4103/jets.jets_27_25
Anshul Kumar, Agrawal Kavita Khemchand, Rajesh Kumar Bansiwal, Rajeev Sharma
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引用次数: 0

摘要

损伤控制手术(DCS)已经彻底改变了严重结直肠病理危重患者的管理。DCS原理最初是为战时创伤而开发的,现已适用于紧急结肠直肠手术,强调快速污染控制、生理稳定和分阶段手术修复。本病例系列强调了救助剖腹手术在处理危及生命的结直肠紧急情况中的作用。本丛书介绍7例年龄24-76岁的患者,因穿孔(自身异物插入和创伤)、肠扭转、恶性梗阻和炎症性疾病等各种情况接受紧急结直肠手术。手术干预包括初级修复、哈特曼手术、转移造口和肿瘤活检减压。术后管理侧重于脓毒症控制和营养支持,导致患者预后良好。由于脓毒症、血流动力学不稳定和延迟治疗相关的并发症的高风险,紧急结直肠手术提出了重大挑战。DCS,特别是救助剖腹手术,优先考虑患者稳定而不是立即确定修复,降低术中风险。这种方法在减少术后并发症护理的同时成功地提高了生存率。尽管DCS具有优势,但需要仔细选择患者,以避免不必要的分阶段干预和延长住院时间。通过在最终修复前允许生理稳定,这种方法提高了生存率并减少了并发症。战时手术原则适应现代民用实践,强调DCS在紧急胃肠手术中的作用不断发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Abbreviated Laparotomy in Emergency Colorectal Disease from Battlefield Innovations to Modern Practice.

Damage control surgery (DCS) has revolutionized the management of critically ill patients with severe colorectal pathology. Initially developed for wartime trauma, DCS principles have been adapted to emergency colorectal surgery, emphasizing rapid contamination control, physiological stabilization, and staged surgical repair. This case series highlights the role of bailout laparotomy in managing life-threatening colorectal emergencies. This series presents seven patients aged 24-76 years, undergoing emergency colorectal surgery for varied conditions such as perforation (self-foreign body insertion and trauma), volvulus, malignant obstruction and inflammatory diseases. Surgical interventions included primary repair, Hartmann's procedure, diversion stomas, and tumor biopsy with decompression. Postoperative management focused on sepsis control and nutritional support, leading to favorable patient outcomes. Emergency colorectal surgery presents significant challenges due to the high risk of sepsis, hemodynamic instability, and complications associated with delayed treatment. DCS, particularly bailout laparotomy, prioritizes patient stabilization over immediate definitive repair, reducing intraoperative risks. This approach has demonstrated success in improving survival rates when minimizing postoperative morbidity care. Despite its advantages, DCS requires careful patient selection to avoid unnecessary staged interventions and prolonged hospitalizations. By allowing physiological stabilization before definitive repair, this approach enhances survival and reduces complications. The adaptation of wartime surgical principles to modern civilian practice underscores the evolving role of DCS in emergency gastrointestinal surgery.

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来源期刊
CiteScore
2.90
自引率
7.10%
发文量
52
审稿时长
39 weeks
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