外伤性小肠破裂85例分析(1)
【摘要】 目的 探讨外伤性小肠破裂的诊断与治疗。方法 分析总结本院从1996-2006年间收治的85例外伤性小肠破裂患者的临床资料。结果 分析85例小肠破裂的临床症状体征和实验室改变，确定诊断的依据。单纯修补30例，肠部分切除49例，修补加肠减压6例，83例治愈，2例死亡。结论 临床症状、体征和必要的辅助检查资料对外伤性小肠破裂具有重要的意义。治疗以手术为主，单纯修补和肠部分切除是重要的治疗手段 。
【关键词】 外伤性;小肠破裂；诊断；治疗
Analysis of 85 cases of traumatic rupture of small intestine
BAO Wei,WANG Hao-wei,ZHANG Ding，et al.Department of General Surgery,Workers Hospital of Suining,Suining,Jiangsu 221200,China
, http://www.100md.com
【Abstract】 Objective To probe into the diagnosis and treatment of traumatic rupture of small intestine(TRSI).Methods There were 85 cases of TRSI who had undergone operation in our hospital were retrospectively received from 1996 to 2006.Results The materials of clinical symptoms,signs and lab detection of 85 cases of such patients were analyzed and diagnosis had obtained.The simple repair was underwent in 30 cases,partial intestinal resection and anastomosis was underwent in 49 cases and intestinal decompression was underwent in 6 cases.Of the 85 cases of TRSI,83 cases recovered smoothly after operation.2 cases died.Conclusion Clinical symptom and signs as well as the auxiliary diagnosis are very important for diagnosis of TRSI.The main treatment should be operated according to situation and simple repair or partial resection could be performed.
, 百拇医药
【Key words】 Traumatic;Rupture of intestine;Diagnosis;Treatment
外伤性小肠破裂虽在腹部损伤中较常见，由于缺乏特异性的诊断方法[1],临床上延误诊断和处理不当仍时有发生，本院1996-2006年12月共手术治疗外伤性小肠破裂85例，均经手术证实，现就其诊治分析如下。
1 临床资料
1.1 一般资料 本组男67例，女18例，年龄15~70岁，其中20~50岁57例。损伤原因：闭合性损伤71例，占84%，其中交通事故钝器伤59例,坠落伤7例,疝强行回纳5例;开放性损伤14例，占16%，其中锐器刺伤10例，人流肠穿孔4例。并发其他脏器伤：骨折4例，胸外伤5例，脑外伤5例。受伤后入院时间：受伤后入院时间[2]。
我们在工作中体会到：①腹部X线检查是简单易行的辅助方法。一般认为10 ml气体进入腹腔便可显示膈下游离气体但由于小肠含气少，膈下游离气体的阳性率低，有局限性，阳性有诊断意义。本组阳性率52%;②诊断性腹腔穿刺 腹腔穿刺具有创伤小、阳性率高、操作简便的优点。 本组阳性率80%，比文献报道略低[3]。穿刺阴性结果不能排除诊断。为提高腹腔穿刺阳性率，减少穿刺并发症，先让患者取伤侧斜卧位5 min后再行穿刺，并强调选用9号粗针头，当有腹膜突破感后缓慢边进边吸。我们认为简单易行,快速诊断,不受自身条件的限制,能为早期诊断提供依据[4];③超声检查 腹部B超检查可发现腹腔积液积气，并可明确有无实质性脏器破裂,作为鉴别诊断,有利于小肠破裂的诊断。本组检查阳性率为52.8%,低于文献报道 [5];④腹部CT能发现肠壁水肿,腹部少量气体,肠系膜血肿及后腹膜改变,对早期诊断有鉴别意义;⑤腹腔镜检查：具有直接观察腹腔内脏器的优点，目前应用日趋广泛，我们无此经验;⑥剖腹探查术。既是诊断手段又是治疗手段，对难以确诊又具备剖腹指征者，应积极准备及时进行剖腹手术，以便早期诊断早期治疗。, http://www.100md.com(鲍 威 王浩伟 张 鼎 朱动传)
【关键词】 外伤性;小肠破裂；诊断；治疗
Analysis of 85 cases of traumatic rupture of small intestine
BAO Wei,WANG Hao-wei,ZHANG Ding，et al.Department of General Surgery,Workers Hospital of Suining,Suining,Jiangsu 221200,China
, http://www.100md.com
【Abstract】 Objective To probe into the diagnosis and treatment of traumatic rupture of small intestine(TRSI).Methods There were 85 cases of TRSI who had undergone operation in our hospital were retrospectively received from 1996 to 2006.Results The materials of clinical symptoms,signs and lab detection of 85 cases of such patients were analyzed and diagnosis had obtained.The simple repair was underwent in 30 cases,partial intestinal resection and anastomosis was underwent in 49 cases and intestinal decompression was underwent in 6 cases.Of the 85 cases of TRSI,83 cases recovered smoothly after operation.2 cases died.Conclusion Clinical symptom and signs as well as the auxiliary diagnosis are very important for diagnosis of TRSI.The main treatment should be operated according to situation and simple repair or partial resection could be performed.
, 百拇医药
【Key words】 Traumatic;Rupture of intestine;Diagnosis;Treatment
外伤性小肠破裂虽在腹部损伤中较常见，由于缺乏特异性的诊断方法[1],临床上延误诊断和处理不当仍时有发生，本院1996-2006年12月共手术治疗外伤性小肠破裂85例，均经手术证实，现就其诊治分析如下。
1 临床资料
1.1 一般资料 本组男67例，女18例，年龄15~70岁，其中20~50岁57例。损伤原因：闭合性损伤71例，占84%，其中交通事故钝器伤59例,坠落伤7例,疝强行回纳5例;开放性损伤14例，占16%，其中锐器刺伤10例，人流肠穿孔4例。并发其他脏器伤：骨折4例，胸外伤5例，脑外伤5例。受伤后入院时间：受伤后入院时间[2]。
我们在工作中体会到：①腹部X线检查是简单易行的辅助方法。一般认为10 ml气体进入腹腔便可显示膈下游离气体但由于小肠含气少，膈下游离气体的阳性率低，有局限性，阳性有诊断意义。本组阳性率52%;②诊断性腹腔穿刺 腹腔穿刺具有创伤小、阳性率高、操作简便的优点。 本组阳性率80%，比文献报道略低[3]。穿刺阴性结果不能排除诊断。为提高腹腔穿刺阳性率，减少穿刺并发症，先让患者取伤侧斜卧位5 min后再行穿刺，并强调选用9号粗针头，当有腹膜突破感后缓慢边进边吸。我们认为简单易行,快速诊断,不受自身条件的限制,能为早期诊断提供依据[4];③超声检查 腹部B超检查可发现腹腔积液积气，并可明确有无实质性脏器破裂,作为鉴别诊断,有利于小肠破裂的诊断。本组检查阳性率为52.8%,低于文献报道 [5];④腹部CT能发现肠壁水肿,腹部少量气体,肠系膜血肿及后腹膜改变,对早期诊断有鉴别意义;⑤腹腔镜检查：具有直接观察腹腔内脏器的优点，目前应用日趋广泛，我们无此经验;⑥剖腹探查术。既是诊断手段又是治疗手段，对难以确诊又具备剖腹指征者，应积极准备及时进行剖腹手术，以便早期诊断早期治疗。, http://www.100md.com(鲍 威 王浩伟 张 鼎 朱动传)