结直肠损伤的诊断和手术治疗  

The diagnosis and surgical treatment of colorectal injuries

作　　者：赵山红[1] 高劲谋[1] 胡平[1] 艾涛[1] 薛兴森[1] 

机构地区：[1]重庆市急救医疗中心重庆市第四人民医院创伤科,400014

出　　处：《中华普通外科杂志》2014年第2期112-114,共3页Chinese Journal of General Surgery

摘　　要：目的 总结结直肠损伤的早期诊断和救治经验.方法 回顾性分析2001年1月至2012年12月重庆市急救医疗中心收治的72例结直肠损伤患者的临床资料. 结果 本组72例结直肠损伤患者的ISS评分平均为29 ±18；钝性伤45例,穿透伤27例；腹膜内结直肠伤57例,腹膜外直肠伤15例；入院时伴休克28例,合并多发伤69例.诊断：伤道探查13例,直肠指检3例,镜检1例,造影剂注入2例,剖腹探查53例.治疗：修补术46例,切除吻合术6例,结肠造口术18例,远、近端结扎2例.术后死亡5例,死亡组平均ISS评分43 ±7,死因为失血性休克3例,严重颅脑伤1例,术后全身炎症反应综合征和多器官功能不全综合征1例.存活者中与结直肠损伤相关并发症发生率为13％ （9/67）,均治愈.结论 早期诊断、及时手术是救治结直肠损伤成功的关键；准确把握一期手术适应证；对腹膜外直肠伤应分期手术.Objective To assess early diagnosis and treatment experience of colorectal injuries.Methods We retrospectively analyzed the clinical data of 72 patients with colorectal injuries in January 2001 to December 2001.Results In this group of 72 cases,ISS score was 29 ± 18.Forty-five suffered from blunt injuries,27 cases from penetrating wounds,Peritoneal colorectal injuries in 57 cases,extraperitoneal rectal injury in 15 cases.Hemorrhagic shock existed in 28 patients at admission.69 were with multiple injuries.Diagnosis：injury tract probing in 13 cases,digital rectal inspection in 3 cases,microscopy in 1 case,the contrast examination in 2 cases,laparotomy in 53 cases.Treatment：repairment in 46 cases,injuried bowel excision anastomosis in 6 cases,18 cases underwent colostomy.5 cases died postoperatively with ISS score of 43 ± 7,among those 3 cases died of uncontrolled hemorrhagic shock,one of severe craniocerebral injury,one of postoperative SIRS and MODS.Other nonlethal postoperative complications occurred in 13% （9/67）,all were cured.Conclusions Early diagnosis and emergency operation is the key to successful treatment for colorectal injuries.The indication of one stage operation should be strict and accurate.Staged operation should be adopted in cases of extra-abdominal rectal injury.

关 键 词：创伤和损伤 诊断 结直肠外科手术 

分 类 号：R656[医药卫生—外科学]