腹部创伤漏诊二次手术18例分析

Analysis of 18 missed diagnosed cases with second operation for abdominal trauma

目的探讨腹部创伤行二次手术患者的原因及引起漏诊的相关因素。方法对18例腹部创伤二次手术患者的临床资料进行回顾性分析,明确治疗和再次手术情况,并分析总结再手术原因。结果 18例二次手术患者死亡2例,致死率11.11%。共进行二次手术20例次,平均手术时间(12.3±1.6)d,生存患者平均住院时间(31.2±5.2)d。18例二次手术患者首次手术漏诊比例较高,占61.11%,较并发症和手术处置失误两个因素差异有统计学意义(χ2=5.600,7.480,P<0.05)。结论由于腹部创伤的特殊性,常伴发多处损伤,因而无论术前、术中均应全面仔细的进行检查和探查,尤其应关注深部组织部位,以减少漏诊,提高一次手术成功率。

Objective To investigate the cause and related factors of second operation and missed diagnosis. Methods A retrospective analysis was made on the clinical data of 18 patients who undergoing second operation for abdominal trauma. Their treatment and operation condition was clarified, and the causes for second operation were analyzed. Results Among the 18 case of second operation, there were 2 death cases with the fatality rate as 11.11%. The second operation was totally performed for 20 cases, with the average operation time as（12.3±1.6） d and average hospital stays as（31.2±5.2） d. The operation missed diagnosis rate was 61.11% in the 18 cases, and the difference from complications and operation mistakes had statistical significance（χ2=5.600, 7.480, P〈0.05）. Conclusion Abdominal trauma has the specificity of multiple injuries, therefore it is necessary for detailed examination and inspection before and during operation, especially for deep tissue, in order to reduce missed diagnosis and to increase success rate of first operation.