外伤性迟发性结肠破裂21例分析

Analysis of Traumatic and Delayed Colon Injury in 21 Cases

目的:探讨外伤性迟发性结肠破裂的临床特征、诊断和治疗方法,提高早期确诊率和治疗疗效。方法:对21例结肠损伤患者的临床资料进行回顾性分析。结果:全组患者均行二期手术治愈。6例患者术后切口感染,4例肠粘连。无造瘘术后肠梗阻、造瘘口狭窄及切口疝等并发症。结论:二期手术适用于严重的休克,全身状态不佳,腹内多脏器损伤和严重的感染。治疗外伤性迟发性结肠破裂重要的是准确判断结肠损伤程度和范围,了解合并损伤的脏器,术中仔细探查,彻底进行肠道和腹腔冲洗,并严格清创和消毒。

Objective： To study the clinical characteristics, the diagnosis and management of traumatic and delayed colon injury in order to improve the efficiency of early diagnosis and treatment. Methods.. The clinical data of 21 consecutively admitted patients with colon injuries were retrospectively reviewed. Results.. All 21 patients were cured by two-stage operation. Common complications included incisional infection in six cases and intestinal adhesion in four cases. No intestinal obstruction after diverting colostomy, narrow fistula and incisional hernia was found. Conclusion.. Indications for diverting colostomy are severe shock, poor condition, heavy intra-abdominal associated organ injuries and contamination. It is important to judge accurately the trauma extent and range, appraise other organ injuries, carefully explore during operation, thoroughly irrigate peritoneal cavity and intestinal tract, strictly debride and sterilize.