伴多发伤的结直肠损伤的诊治

Diagnosis and Treatment of Colorectal Trauma Associated with Multiple Injuries

探讨伴多发伤的大肠损伤25例诊治经验。25例中．男23例，女2例．年龄18～56岁。闭合性损伤11例，开放性损伤14例。其中升结肠3例．横结肠8例．脾曲2例，降结肠2例，乙状结肠4例，肛门直肠6例。1例升结肠上端伤和1例脾曲伤在充分游离局部后，发现分别为近全周断裂和前后壁穿通；另1例十二指肠水平段穿通伤，第一次手术探查漏诊。结肠损伤19例经手术探查确诊．直肠损伤均借助指检、X线片及临床症状确诊。处理按先止血后修补原则进行，术式力求简化安全。14例结直肠损伤伤情较重行：朗于术．9例较轻者选用一期手术．2例术中死亡。25例中21例康复，1例自动出院，3例死于严重创伤、损伤性和（或）失血性休克。

The objective of this study was to sum up the experiences of the diagnosis ＆ treatment of colorectal trauma associated with mutiple injuries in 25 cases, of the 25 cases （23 males and2 females age 18-56 years old） .there were 11 closed and 14 open traumata, and from the angle of location, there were 3 at ascending colon, 8 at transverse colon ,2 at splenic flexure, 2 at descending colon, 4 at sigmoid colon and 6 at anorectal segment. One approximate total fragmentation was noticed at up end of ascending colon and one penetrating trauma from anterior to posterior wall was found at splenic flexure after the local tissues were full freed. While one penetrating trauma at horizontal segment of duodenum was misdiagnosed by first surgical exploratory operation. Colonic traumata in 19 cases were confirmed diagnosis by exploratory operation, and rectal traumata were confirmed diagnosis according to digital, X-ray examination and clinical symtoms. Surgical treatments were conducted according to the principle of hemostasia first ＆ repair second ,and the surgical procedure should be simple ＆ safe. As results, 14 cases with severe colorectal trauma underwent secondary operation, 9 light cases underwent primary operations and 2 cases were dead during operation, of the 25 cases, 21 were cured, 1 was discharged by the patient himself, and 3 cases were dead of severe trauma, traumatic and （or） hemorrhagic shock.