中国实用外科杂志

中国实用外科杂志

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腹部闭合伤延迟性肠坏死11例诊治分析

罗天航，卢正茂，吴建国，薛绪潮，华积德，方国恩   

  1. 第二军医大学附属长海医院普外科，上海 200433
  • 发布日期:2012-01-18

  • Published:2012-01-18

摘要：

目的    探讨腹部闭合性损伤延迟性肠坏死的诊断与治疗。 方法    回顾性分析2000年1月至2008年1月第二军医大学附属长海医院普外科治疗415例腹部闭合性损伤的临床资料，其中11例（2.65%）发生延迟性肠坏死，均于明确诊断后行手术治疗。 结果    8例行一期肠段切除吻合术，3例因腹腔污染严重无法行一期确定性手术，先施行肠造口术，6个月后再行二期肠吻合术。11例全部治愈，其中2例发生肠瘘，经积极治疗后痊愈。 结论    腹部闭合性损伤致延迟性肠坏死临床症状不典型，易导致漏诊或延迟处理，病死率高，临床医生应严密动态观察，CT的正确诊断率较高，早期剖腹探查有利于提高治疗效果。

关键词: 肠坏死, 腹部闭合伤

Abstract:

Diagnosis and treatment of intestinal necrosis following blunt abdominal trauma: an analysis 11 cases        LUO Tian-hang，LU Zheng-mao，WU Jian-guo，et al. Department of General Surgery, Changhai Hospital of the Second Military Medical University，Shanghai 200433, China
Corresponding  author ：FANG Guo-en，E-mail：fangguoen@126.com
Abstract    Objective    To evaluate the diagnosis and treatment of intestinal necrosis following blunt abdominal trauma.Methods    The clinical data of 415 cases of blunt abdominal trauma admitted from January 2000 to January 2008 at Changhai Hospital of the Second Military Medical University were analyzed retrospectively. A total of 11 cases （2.65%）were performed operation to be diagnosed as delayed intestinal necrosis following blunt abdominal trauma. Results    A total of 8 cases were underwent partial intestinal or colorectal resection and anastomosis. Three cases were performed enterostomy firstly because of severe abdominal contamination, then performed intestinal or colorectal anastomosis after six months. All the cases were cured, and intestinal fistulas occurred in 2 cases who were then cured by suitable therapy. Conclusion    The clinical features of intestinal necrosis following blunt abdominal trauma are rather difficult to be diagnosed correctly in the early stage. CT scan is the most sensitive preoperational examination and reasonable operative procedure is the key to promote the effects of the treatment.

Key words: intestinal necrosis, blunt abdominal trauma