闭合性腹部创伤中肠道损伤的诊断与治疗

Diagnosis and treatment of intestinal injury in closed abdominal injury

腹部闭合性损伤中肠道损伤的诊断和治疗是腹部创伤治疗的难点和重点。肠管损伤容易漏诊,有文献报道,肠道(尤其是腹膜后结肠等部位)损伤漏诊或误诊率高达30%~40%,由此导致严重的并发症。近年来随着介入技术的发展,腹部创伤中实质脏器尤其是出血的非手术治疗日益常见,此时越来越重要的一环是判断肠道损伤的情况和是否需要及时的手术治疗。本文就闭合性腹部创伤中肠道损伤致伤机制、临床表现、评估技术、剖腔探查、腹腔镜探查作一综述。

The diagnosis and treatment of intestinal injury in closed abdominal injury is the difficulty and emphasis in the treatment of abdominal injury.Intestinal injury is easy to be missed.Some literatures have reported that the rate of missed diagnosis or misdiagnosis of intestinal injury(especially the retroperitoneal colon)is as high as 30%-40%,and the missed diagnosis and misdiagnosis of intestinal injury will lead to serious complications.In recent years,with the development of interventional techniques,non-surgical treatment of parenchymal viscera,especially hemorrhage,is increasingly common in abdominal injury.At this time,it is more and more important to judge the situation of intestinal injury and whether timely surgical treatment is needed.This article reviews the injury mechanism,clinical feature,assessment technology,abdominal laparotomy and laparoscopic exploration in the diagnosis and treatment of intestinal injury in closed abdominal trauma.