134例外伤性小肠破裂的诊断及治疗

Traumatic rupture of small intestine in diagnosis and treatment strategies of 134 patients

目的探讨诊断和治疗外伤性小肠破裂的措施。方法回顾性分析134例外伤性小肠破裂患者的临床资料。男82例,女52例;年龄12～61岁,平均年龄29.3岁。伤后至就诊时间8 min～40 h,平均就诊时间4.9 h。损伤情况:回肠破裂84例,空肠破裂42例,十二指肠破裂4例,空回肠交界部位4例。小肠破裂2处76例,1处58例。结果腹腔穿刺阳性率92%,腹部立位X检查阳性率76%,CT检查阳性率85%。其中112例行单纯性肠修补术,22例行肠切除术。手术后发生并发症30例,占22.4%,死亡6例,占4.5%。结论外伤性小肠破裂诊断以腹部症状、体征为主要依据,结合腹穿、X线及CT检查可提高本病的诊断率。为了减少外伤性小肠破裂术后的并发症和病死率,对其患者要及时合理救治。

Objective To explore the diagnosis and treatment strategies of traumatic rupture of small intestine.Methods The clinical data of 134 patients with traumatic rupture of small intestine were retrospective analyzed.The patients,82 males and 52 females,aged from 12 to 61 years with the mean of 29.3 years.The clinical time after injury ranged from 8 minuets to 40 hours,with the mean of 4.9 hours.Among the patients,ileum rupture in 84 patients,jejunal rupture in 42 patients,duodenal rupture and border area of empty ileum in 4 patients respectively.Small bowel perforation was found on 2 places in 76 patients,on 1 patient in 58 patients.Results The positive rate of abdominal puncture was 92%,the positive rate of abdominal orthostatic X examination was 76%,CT check-positive rate was 85%.112 patients had underwent simple intestinal repair,22 patients had underwent intestinal resection.Postoperative complications were found in 30 patients（22.4%）,6 patients died（4.5%）.Conclusion Diagnosis of traumatic rupture of small intestine with abdominal symptoms for main basis,with paracentesis,X ray and CT examination can improve the diagnosis rate.For reducing postoperative complications and mortality,patients with traumatic rupture of small intestine should be timely and reasonable treatment.