骨盆骨折合并直肠肛管损伤的临床分析  

Pelvic Bone Fracture Associated with Trauma of Rectal and Anal Canal:Clinical Analysis

作　　者：李逢春 LI Feng-chun(Min County＇s People＇s Hospital,Dingxi,Gansu 74840)

机构地区：[1]甘肃省定西市岷县人民医院,甘肃岷县748400

出　　处：《中国肛肠病杂志》2018年第9期21-23,共3页Chinese Journal of Coloproctology

摘　　要：为探讨骨盆骨折合并直肠肛管损伤的治疗方法及注意事项,选取2014年1月至2018年1月甘肃省定西市岷县人民医院收治的21例骨盆骨折合并直肠肛管损伤患者作为研究对象。其中,11例合并失血性休克患者,行抗休克治疗,包括输血、输液等。待休克纠正后4例行双侧髂内动脉结扎术,7例行选择性动脉栓塞术。10例腹膜直肠损伤患者,针对病症行剖腹探查修补术,完成检测与损伤修补,待完成结肠造口后行二期手术,行腹腔冲洗引流。其中的8例腹膜外直肠损伤患者,行手术探查,于盆底处切开腹膜,修补破损直肠,根据修补情况造口后行骨盆冲洗术,并进行骶前间隙引流。其中的3例提肛肌损伤患者为浅表撕裂伤,缝合修补括约肌断端,引流。骨盆骨折症状由骨科医师处理治疗。结果显示,本研究21例患者中治愈19例,死亡2例。治愈率为90.47%(19/21)。死亡原因为骨盆粉碎性骨折合并失血性休克1例,多器官功能衰竭合并粉碎性骨折1例。结果表明,根据患者的病情进行合理评估后选择合适的治疗方法十分重要,这不仅可减少并发症,还可减少患者由于不必要的肠造口而造成的痛苦,同时彻底清创引流、术后应用抗生素及紫外线照射,可减少患者术后感染的发生。To investigate surgical treatment of pelvic bone fracture complicated with trauma of rectal and anal canal,as well as relevant notice something,21 cases of above complication injury admitted in author＇s hospital（2014-01 -- 2018-01） were enrolled in this study, including 11 cases complicated with hemorrhagic shock and 10 cases with peritoneum ＆ rectum injury,which the former cases were given with antishock,i. e, transfusion,etc,once shock rectification,4 cases received bilateral ligation of hypogastric artery,rest ？ cases received selective arteriembolization; the latter cases received laparo-exploratory repair to complete detection and injury repair, until colostomy completed performing secondary operation, and peritoneal lav- age ＆ dranage,among them 8 cases with extraperitoneal rectum injury were given with following surgery exploratory procedure, incisal peritoneum at pelvic floor, repair injuried rectum, then according to repaired status performing pelvis lavage after colostomy, finally sacro-anterior space drainage;rest 3 cases with leva- tor ani muscle injuried（as superficial lacerated wound） were given with suture ＆ repair of sphincter broken end and to drainage,as for fracture＇s management ifs by osteology doctor.As restuls,in all the 21 cases 19 were cured,2 died（l due to comminuted fracture associated with hemorrhagic shock,another 1 due to mul- tiple organ functional failure associated with comminuted fracture）, the curative rate was up to 90.47% （19/21）.Results show that it is very important to choose suitable therapy after rationally evaluating pa- tients＂ condition which not only can reduce complication, but avoid patient＇s pain from unnecessary colosto my; at the same time it should be throughly performing debride drainage, postoperatively using antibiotics and taking ultraviolet radiation so as to reduce postoperative infection.

关 键 词：骨盆骨折 直肠肛管损伤 失血性休克 乙状结肠造瘘 

分 类 号：R683.3[医药卫生—骨科学] R657.1[医药卫生—外科学]