外伤性小肠破裂67例误漏诊分析  

Missed Diagnosis Analysis of 67 Patients with Traumatic Rupture of Small Intestine

作　　者：尹晖明[1] 邓旭[2] 韩洁[3] 黄劲松[1] 刘首记[1] 胡斌[1] 龚利平[1] 谢旭祥[1] 

机构地区：[1]湖南中医药高等专科学校附属第一医院普外科,湖南株洲412000 [2]湖南中医药高等专科学校附属第一医院泌尿外科,湖南株洲412000 [3]湖南中医药高等专科学校附属第一医院药剂科,湖南株洲412000

出　　处：《临床误诊误治》2013年第7期19-22,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨外伤性小肠破裂常见误诊原因及防范措施。方法对我院2002年1月—2012年11月收治误诊漏诊的67例外伤性小肠破裂的临床资料进行回顾性分析。结果本组误诊率为17.8%(67/376),其中基层医院误诊、漏诊41例(61.2%),本院误诊、漏诊26例(38.8%)。误诊为肠梗阻27例,腹膜后血肿引起麻痹性肠梗阻18例;仅诊断脑外伤12例,急性阑尾炎、腹部软组织挫伤各5例,漏诊肠破裂。67例均经手术证实为小肠破裂,术后发生并发症37例(55.2%),1例因多器官功能衰竭死亡(1.5%),66例临床治愈。结论外伤性小肠破裂误诊率较高,临床接诊腹部外伤者应反复查体、腹腔穿刺,必要时行腹腔镜探查,以早期诊断和治疗,减少并发症,降低病死率。Objective To explore missed diagnosis causes and preventive measures of traumatic rupture of small intestine.Methods Clinical data of misdiagnosed or missed diagnosed 67 patients with traumatic rupture of small intestine during January 2002 and November 2012 in our hospital were retrospectively analyzed.Results The misdiagnosis rate was 17.8%（67 /376）,among whom 41 patients（61.2%） were missed diagnosis or misdiagnosed in grass-roots hospitals,and 26 patients（38.8%） were misdiagnosed or missed diagnosis in our hospital.A total of 27 patients were misdiagnosed as having intestinal obstruction,18 of whom were paralytic intestinal obstruction induced by retroperitoneal hematoma;12 patients were only misdiagnosed as having brain injury,5 patients as having acute appendicitis,5 patients as having abdominal soft tissues contusion,and intestinal rupture was missed diagnosis in 12 patients.The 67 patients were confirmed with rupture of small intestine by surgery,among whom,37 patients（55.2%） suffered postoperative complications,1 patient died because of multiple organ failure（1.5%）,and 66 patients were clinically cured.Conclusion The misdiagnosis rate of traumatic rupture of small intestine is high,so clinicians need to perform a thorough physical examination,abdominal paracentesis and necessary laparoscopic approach for patients with abdominal injuries.Quick diagnosis and treatment are helpful in reducing complications and fatality rate.

关 键 词：外伤 小肠 肠破裂 误诊 阑尾炎 肠梗阻 

分 类 号：R656.7[医药卫生—外科学]