骨折合并钝性腹部损伤延迟性肠破裂的诊断治疗  

The Diagnosis and Treatment of Fracture Combined with Delayed Intestinal Rupture in Blunt Abdominal Injury

作　　者：段琨 张伟 刘洪江 

机构地区：[1]核工业四一七医院外一科,陕西西安710054

出　　处：《中国伤残医学》2017年第23期1-3,共3页Chinese Journal of Trauma and Disability Medicine

基　　金：基金项目：陕西省社会发展攻关基金项目（基金编号：2016SF-072）

摘　　要：目的：探讨骨折合并闭合性腹部损伤迟发型肠破裂临床特点及诊断治疗方法.方法：对我院对2016年1月～2016年10月收治的骨折合并闭合性腹部损伤迟发型肠破裂的25例患者的受伤原因、临床表现,诊断措施及治疗过程进行回顾性分析.本组患者男性16例,女性9例.年龄21～ 48岁,平均35＆#177;6.8岁.高处坠落伤13例,车祸伤8例,挤压伤4例,合并骨盆骨折4例,脊柱骨折6例,四肢骨折15例.主要临床表现为伤后骨折处疼痛,畸形,骨折手术后局部疼痛缓解,受伤2～5天后出现腹式呼吸减弱或消失,腹疼,肠鸣音逐渐减弱或消失,腹肌紧张、压痛、反跳痛等腹膜刺激症状.结果：B超提示腹腔积液18例,CT检查气腹征7例,腹腔穿刺阳性17例（80.9％）,行剖腹探查术中发现小肠破裂行修补术14例,小肠坏死切除并吻合术7例,结肠破裂行结肠造瘘术4例,术后6例患者发生并发症,切口感染5例,多脏器衰竭死亡1例.结论：骨折合并闭合性腹部损伤迟发型肠破裂早期无症状或腹痛症状被骨折掩盖而易于漏诊,综合分析受伤机制、动态查体及超声或CT检查、腹腔穿刺等临床资料,早期剖腹探查术是明确诊断和降低并发症的关键.Objective： To investigate the diagnosis and management principle of fracture combined with delayed intestinal rupture. Methods： A total of 25 patients with fracture combined with delayed intestinal rupture from January 2006 to October 2016 were retrospec- tive analysis; Among these 25 cases, there were male 16 cases, female 9 cases with a mean age of 35 ~ 6.8 years （ range 21 to 48 ）, high falling injury in 13 cases, accident injury 8 cases, crush injury 4 cases and 4 cases with pelvic fractures, 6 cases of spinal fracture, 15 ca- ses of limbs fracture. Major clinical manifestations were fracture pain, deformity, after fracture pain relief peritoneal irritation symptoms appear;Results： The ultrasonography, abdominal cavity CT and abdominal puncture were positive, laparotomy found small intestine rup- ture 14 cases, small intestine necrosis excision and anastomosis in 7 cases, colon rupture line colon fistula in 4 cases, one patient died of multiple organ failure and 5 cases incisioninfection. Conclusion： The fracture combined with delayed intestinal rupture mild or asympto- matic cases may miss diagnosis, comprehensive analysis of injury mechanism, dynamic data and ultrasound or CT examination, abdominal puncture,early exploratory laparotomy are the keys to decrease the mortality.

关 键 词：闭合性腹部损伤 迟发型肠破裂 骨折 临床诊断 早期开腹探查 

分 类 号：R656[医药卫生—外科学]