外伤性小肠破裂的临床特点及诊治分析  

Analysis of clinical characteristics and the diagnosis and treatment of traumatic rupture of small intestine

作　　者：高明[1] 项和平[1] 杨俐琪[1] 

机构地区：[1]安徽医科大学第二附属医院,合肥230000

出　　处：《山东医药》2013年第27期40-42,共3页Shandong Medical Journal

基　　金：安徽省科技厅年度科研项目(12070403067)

摘　　要：目的分析外伤性小肠破裂的临床特点及诊治结果,以期提高诊治水平。方法回顾性分析36例外伤性小肠破裂患者的临床资料,包括临床表现、辅助检查、创伤情况及诊治结果。结果 33例闭合性外伤患者均有不同程度的腹痛,部分伴腹膜刺激征阳性、肠鸣音明显减弱或消失、休克,腹腔穿刺总阳性率为90.9%;X线检查提示有膈下游离气体20例,20例行CT检查者中15例示腹盆腔积液;3例开放性损伤患者腹部均有明确外伤史和刀刺伤口,爆炸伤者肠管外露。伤后6 h内确诊20例,6～12 h确诊12例,12～72 h及72 h后各确诊1例;均行手术治疗,其中治愈35例、因肠衰竭放弃治疗1例。结论外伤性小肠破裂多数有腹痛、腹膜刺激征、腹腔穿刺阳性等临床特点,影像学检查及腹腔穿刺等有利于早期诊断,及时手术、积极处理术后并发症是提高治愈率的关键。Objective To investigate the clinical characteristics of traumatic rupture of small intestine in order to improve the level of diagnosis and treatment.Methods Retrospective analysis of the clinical data(clinical manifestation,auxiliary examination,traumatic situations and the diagnosis and treatment results) in 36 patients with traumatic rupture of small intestine was conducted.Results Thirty-three cases of closed injury patients had different degrees of abdominal pain,some with positive peritoneal irritation sign,markedly decreased bowel sounds or disappeared,shock,and the total positive rate of abdominal puncture was 90.9%;X-ray examination showed subdiaphragmatic free air in 20 cases,15 in 20 cases examined by CT showed abdominal and pelvic cavity effusion;3 cases of open injury patients had clear abdominal trauma history and stab wounds,and explosion injured intestine was exposed.20 cases were diagnosed and confirmed within 6 h after injury,12 cases were confirmed in 6-12 h,and 1 case was confirmed in 12-72 h and after 72 h.They were all treated by the operation,35 cases were cured,and 1 case was given up because of intestinal failure.Conclusion Traumatic rupture of small intestine most has abdominal pain,peritoneal irritation signs,and positive abdominal puncture.Imaging examination and abdominocentesis are useful for the early diagnosis.Timely operation and active treatment of post-operative complications are the key to improve the cure rate of traumatic rupture of small intestine.

关 键 词：外伤性小肠破裂 并发症 

分 类 号：R656.7[医药卫生—外科学]