胃肠道创伤诊断与治疗

Diagnosis and Treatment of Gastrointestinal Tract Injuries

目的探讨腹部创伤造成胃肠道损伤(Gastrointestinal tract injuries,GITIs)的诊断与治疗方法。方法收集第二军医大学附属长海医院普外科2004-2013年收治的腹部创伤造成GITIs者117例,进行回顾分析。结果腹部创伤造成胃肠道损伤多见于青年男性,以车祸、坠落伤、钝器伤或锐器伤等多见,其中以小肠损伤最为常见,剖腹探查术主要依据X线检查、B超、CT或腹腔穿刺,或出现循环不稳定。根据损伤的部位及程度采取不同的手术方式。全组死亡1例,13例发生并发症。单因素Logistic回归分析显示,并发症发生率与创伤严重度评分(injury severity score,ISS)、年龄、损伤部位的数量、损伤到手术时间(6 h以内或超过6 h)无关,而与术中的输血量有关(P<0.05)。结论 GITIs在腹部创伤中并不少见,对可疑GITIs者可反复行B超、X线、CT或腹腔穿刺检查。GITIs造成的术后并发症相对较低,主要可能与术中的出血量有关,提示在处理胃肠道创伤时要首先控制出血。

Objective To discuss the diagnosis and treatment of gastrointestinal tract injuries（GITIs） induced by abdominal trauma. Methods 117 patients with GITIs induced by abdominal trauma were enrolled for retrospective study,all of whom were admitted to our hospital from 2004 to 2013. Results Most of the GITIs induced by abdominal trauma were seen in young men. It gave priority to traffic accident,falling injuries,blunt or sharp instrument injury,etc.,in which the small intestine injury was most common. Exploratory laparotomy was mainly based on X- ray,B- ultrasonography,computed tomography（CT）,or abdominocentesis,some time based on haemodynamic instability. Different surgical modes were adopted due to the sites and degrees of injuries. 1 case died,and complications developed in 13 cases. Logistic regression for univariate analysis indicated that the complication incidences was not related to the injury severity score（ISS）,age,numbers of injury sites,duration from injury to surgery（ 6h or 6h）,but was related to the intra- operative volume of transfusion（P〈0.05）. Conclusion GITIs are not rare in abdominal trauma. For suspicious GITIs patients,X-ray,B-ultrasonography,computed tomography（CT）,or abdominocentesis can be given repeatedly. GITIs- associated complication incidence is relatively small,which might be related to the intra- operative transfusion volume,suggesting that bleeding control is the first step in abdominal trauma treatment.