急腹症术后非计划再次手术的原因分析及防治

Causes and preventive measures of unplanned reoperations after acute abdomen operation

目的探讨急腹症术后非计划再次手术的原因及其防治措施。方法回顾分析2013年1月至2018年7月福建医科大学附属宁德市医院普外二科收治的46例因不同原因施行非计划再次手术的急腹症病人临床资料。结果 1 104例急腹症手术病人中,术后行非计划再次手术46例,再次手术发生率为4.1%。非计划再次手术按原因可分为:腹腔术后活动性出血11例(胆囊床活动性出血2例,胰周创面出血2例,脾静脉出血2例,胃短血管出血2例,肠系膜血管出血2例,阑尾动脉结扎线脱落1例),占23.9%;粘连性肠梗阻9例,占19.6%;腹腔内感染9例(右膈下脓肿2例,肠间脓肿1例,盆腔脓肿6例),占19.6%;消化液漏7例(吻合口漏4例,十二指肠残端漏3例),占15.2%;切口裂开6例,占13.0%;副损伤3例(胆总管损伤1例,脾脏撕裂伤1例,回肠穿孔1例),占6.5%;切口疝1例,占2.1%。经过再次手术,44例痊愈出院,2例死亡。结论重视急腹症术后非计划再次手术,针对其常见原因采取合理预防及治疗措施,有利于提升医疗质量。

Objective To investigate the reason,prevention,and treatment measures of unplanned reoperations after acute abdomen operation.Methods The clinical data of 46 patients with unplanned reoperations after acute abdomen operation were analyzed between January 2013 and July 2018 in the Second Department of General Surgery,Ningde Municipal Hospital Affiliated to Fujian Medical University.Results In 1 104 cases of acute abdomen,46 patients underwent unplanned reoperations,and the reoperation rate was 4.1%.The causes of unplanned reoperations were active bleeding in 11 cases(23.9%)including 2 cases of active hemorrhage of gallbladder bed,2 cases of peripancreatic wound bleeding,2 cases of splenic vein bleeding,2 cases of bleeding from short gastric vessels,2 cases of mesenteric vascular hemorrhage and 1 case of appendix artery ligation line abscission;adhesive intestinal obstruction in 9 cases(19.6%);intra-abdominal infection in 9 cases(19.6%),including 2 cases of right inferior phrenic abscess,1 case of intestinal abscess and 6 cases of pelvic abscess;leakage of digestive juice in 7 cases(15.2%),including 4 cases of anastomotic leakage,3 cases of duodenal stump leakage;incision rupture in 6 cases(13.0%);accessory injury in 3 cases(6.5%),including 1 case of common bile duct injury,1 case of splenic laceration,and 1 case of ileum perforation;incisional hernia in 1 case(2.1%).After reoperation,44 patients were cured and 2 died.Conclusions Attaching importance to the unplanned reoperation of acute abdomen and taking reasonable preventive and therapeutic measures against common causes are conducive to improving medical quality.