结直肠损伤诊断治疗策略  

Diagnosis and treatment of colorectal injuries

作　　者：张连阳[1] 王韬[1] 李英才[1] 刘朝普[1] 孙士锦[1] 姚元章[1] 黄显凯[1] 张胜本[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军战创伤中心,重庆400042

出　　处：《创伤外科杂志》2008年第4期295-297,共3页Journal of Traumatic Surgery

摘　　要：目的 探讨结直肠损伤的诊断治疗情况。方法回顾性分析2000年1月以来收治的44例结直肠损伤，其中男性33例，女性11例；年龄3～77岁，平均34岁。钝性伤27例，穿透伤13例，医源性损伤4例；伤后直接送至我院35例，由其他医院外科处理后转至我院9例。行近端肠道造口7例；外置3例；Ⅰ期修补30例，切除损伤肠段后Ⅰ期吻合3例。结果早期确诊41例，3例外院转运来的患者分别延误诊断1、7天和2个月。结直肠损伤AIS评分2—5分，平均2．9分；多发伤15例，ISS评分10～43分，平均22．1分；腹盆腔多脏器损伤15例。我院早期救治的35例伤后至确定性手术时间0．75—8小时，平均2．5小时。治愈43例，1例因严重骨盆碾压伤、失血性休克死亡；发生并发症6例（13％），肺梗塞、结肠修补处瘘、低位小肠梗阻、造口黏膜坏死各1例，腹腔内脓肿2例。结论结直肠损伤诊断主要依靠术中探查，Ⅰ期手术可安全用于多数病例。Objective To explore the diagnosis and treatment of colorectal injuries. Methods Retrospective analysis was made on the clinical data of 44 cases of colorectal injuries from January 2000 up to now including 33 male patients and 11 female patients, ranged from 3 to 77 （average 1341 years. Blunt trauma was found in 27, penetrating wound in 13 ,and iatrogenic trauma in 4. Among these cases,35 of them were admitted directly , the rest were transferred from other hospitals after surgical management. Of these patients,7 had proximal colostomy, 3 had exteriorization,30 had one stage repairs3 had one stage inosculation after resecting impaired intestine. Results Forty-one cases were diagnosed early ,3 cases transferred from other hospitals were delayed 1 day ,7days and 2 months respectively. AIS score of colorectal injuries ranged form 2 to 5（ average,2.91. ISS score of 15 multiple injuries ranged form 10 to 43（ average,22.11. Fifteen cases had multiple injuries in abdominal cavity and pelvic cavity. The time from injury to operation of 35 admitted directly ranged from 0.75 to 8 （ averge , 2.51 hours. Forty-three cases cured completely,and 1 case died of hemorrhagic shock. Six cases（ 13% ） had complications （ lung infarction , colonic fistula , obstruction of lower part of small intestine , necrosis of stoma mucosa in 1 respectively , and abdominal abscess in 21. Conclusion The diagnosis of colorectal injuries depends on exploratory laparotomy. One stage operation is safe for most of cases.

关 键 词：结直肠损伤 诊断 治疗 

分 类 号：R656.9[医药卫生—外科学]