创伤性腹腔脏器破裂428例救治分析

Experience in Diagnosis and Treatment of 428 Patients with Traumatic Visceral Rupture

目的探讨创伤性腹腔脏器破裂患者的有效救治方法。方法选择解放军第306医院及江苏大学附属武进医院2000—2009年收治的创伤性腹腔脏器破裂患者428例,回顾性分析患者的诊断、治疗方法、并发症及死亡原因。结果 428例患者共死亡24例,病死率为5.61%,死亡原因为严重多发伤并创伤性休克、胰瘘及腹腔感染并发多器官功能衰竭。并发症:切口及腹腔感染18例,胰瘘5例,肠梗阻3例,轻度十二指肠瘘2例,均经积极治疗而痊愈。结论内脏破裂的早期识别和诊断十分关键,剖腹探查应全面仔细,不忽略隐蔽性损伤。采用"四大一支持"综合疗法能改善微循环,拮抗炎性递质及遏止患者危重状态进展并使患者度过麻醉和手术的第三次打击。

Objective To summarize the experience in the diagnosis and treatment of traumatic visceral rupture（TVR）.Methods The clinical data of 428 with TVR who were treated in our centers from 2000 to 2009 were retrospectively analyzed.Results The mortality rate was 5.61%（24/428）,mainly due to traumatic shock,leakage of pancreas,abdominal infection,and multiple organ dysfunction syndrome.Complications such as leakage of pancreas（n=5）,mild duodenal fistula（n=2）,and abdominal wall and cave infections（n=18）were cured after active management.Conclusion Early identification and diagnosis is important for a better outcome of the traumatic visceral rupture.Integrated management can improve microcirculation,fight against inflammatory mediators,reverse the critical conditions,and thus help the patients recover well.