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Abstract：
The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons.
Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications.
Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data.
In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy.
Systematic review/meta-analysis, level III.
Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications.
Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data.
In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy.
Systematic review/meta-analysis, level III.
摘要：
在过去的四十年中，平民穿透性结肠损伤的管理已经发展。这项荟萃分析的目的是评估当前可用于穿透性结肠损伤的治疗方案，并评估吻合在损伤控制手术中的作用，以制定外科医生的实践管理指南。
使用建议评估的分级，发展,和评估(等级)方法，EAST实践管理指南部分的一个小组委员会使用MEDLINE和EMBASE从1980年到2017年的文章进行了系统审查.我们提出了三个相关问题，干预，比较,关于穿透性结肠损伤的结果（PICO）问题。感兴趣的结果包括死亡率和感染性腹部并发症。
确定了37项研究进行分析，其中16例符合定量荟萃分析标准,纳入了6项前瞻性随机研究中被认为是低风险的705例患者.在一项单独的荟萃分析中，纳入了10项接受损伤控制剖腹手术，修复或切除和吻合（R＆A）的研究中的78名患者。由于数据不足，对接受修复或R＆A的高危患者进行荟萃分析是不可行的。
在没有休克迹象的结肠穿透性损伤的成年平民患者中，大量出血，严重污染,或延迟手术干预，我们建议进行结肠修复或R＆A，而不是常规结肠造口术。在患有穿透性结肠损伤的成人高危平民创伤患者中，我们有条件地建议进行结肠修复或R&A,而不是常规结肠造口术.在患有穿透性结肠损伤的成年平民创伤患者中，进行了损伤控制剖腹手术，我们有条件地建议不进行常规结肠造口术；相反，应在初次手术时进行明确的修复或延迟的R＆A或吻合，而不是常规的结肠造口术。
系统评价/荟萃分析，三级。
使用建议评估的分级，发展,和评估(等级)方法，EAST实践管理指南部分的一个小组委员会使用MEDLINE和EMBASE从1980年到2017年的文章进行了系统审查.我们提出了三个相关问题，干预，比较,关于穿透性结肠损伤的结果（PICO）问题。感兴趣的结果包括死亡率和感染性腹部并发症。
确定了37项研究进行分析，其中16例符合定量荟萃分析标准,纳入了6项前瞻性随机研究中被认为是低风险的705例患者.在一项单独的荟萃分析中，纳入了10项接受损伤控制剖腹手术，修复或切除和吻合（R＆A）的研究中的78名患者。由于数据不足，对接受修复或R＆A的高危患者进行荟萃分析是不可行的。
在没有休克迹象的结肠穿透性损伤的成年平民患者中，大量出血，严重污染,或延迟手术干预，我们建议进行结肠修复或R＆A，而不是常规结肠造口术。在患有穿透性结肠损伤的成人高危平民创伤患者中，我们有条件地建议进行结肠修复或R&A,而不是常规结肠造口术.在患有穿透性结肠损伤的成年平民创伤患者中，进行了损伤控制剖腹手术，我们有条件地建议不进行常规结肠造口术；相反，应在初次手术时进行明确的修复或延迟的R＆A或吻合，而不是常规的结肠造口术。
系统评价/荟萃分析，三级。
