腹部外伤术后近期再手术38例

Analysis of 38 cases of reoperation after abdominal trauma

目的探讨腹部外伤术后近期再手术的原因、预防及处理措施。方法回顾性分析1999年3月至2009年10月收治的38例腹部外伤术后近期因不同原因非计划性再手术病人的临床资料。结果再手术38例中,腹腔大出血9例,消化道瘘8例,胰瘘4例,胆漏3例,腹腔脓肿5例,肠梗阻4例,小肠坏死1例,切口裂开2例,阴性再手术1例,肝脓肿1例。再次手术后死亡4例(10.5%),余痊愈。结论术中探查仔细,操作精细,加强术后观察,提高首次手术质量,是提高腹部外伤疗效的关键;而合理掌握再手术指征、实施及时有效的再次手术可避免疾病进一步恶化。

Objective To investigate the causes, prevention and treatment of unplanned reopera- tion after abdominal trauma. Methods A retrospective analysis was done on the clinical data of 38 ca- ses of unplanned reoperations after abdominal trauma from Mar. 1999 to Oct. 2009. Results Among 38 cases of reoperations,abdominal bleeding occurred in 9 cases,gastrointestinal fistula in 8 cases, pan- creatic fistula in 4 cases, bile leakage in 3 cases,intra-abdominal abscess in 5 cases,obstruction in 4 cases,intestinal necrosis in 1 case,incision rupture in 2 cases, reoperation without findings in 1 case,liver abscess in 1 case. There were 4 deaths following reoperations（10. 5 % ）, and the remaining cured. Conclusion Careful exploration during the surgery, fine operation, enhancement of postoperative observation and improvement of the quality of the first surgery are the key points of the abdominal trauma. Comprehension of indications for reoperation and effective re-operations in time can avoid the exac- erbation of the diseases.