迟发表现的胃肠道创伤诊治分析

Diagnosis and treatment of gastrointestinal trauma with delayed expressions

目的总结迟发表现的胃肠道创伤诊治病例,提高对此类损伤的认识和救治水平。方法回顾性分析2004年10月—2018年5月陆军军医大学西南医院收治的迟发胃肠道损伤患者17例,其中男性13例,女性4例;年龄17~58岁,平均39.3岁;道路交通伤9例,坠落伤5例,击打伤2例,砸伤1例。受伤当时表现不能确定胃肠道破裂,通过动态观察症状体征改变结合辅助检查后进行剖腹探查手术,受伤后2~21d手术后确诊。治疗方式:十二指肠破裂行引流,备二期修补,小肠和胃创伤行吻合术治疗,结肠损伤行造口治疗,二期再行吻合术。结果其中2例胃壁挫伤坏死,行部分切除修补;2例十二指肠破裂行引流、空肠造口;5例小肠破裂坏死行部分肠段切除,端端吻合;1例回肠破裂行造口。2例横结肠坏死行部分坏死切除近端造口,2例乙状结肠破裂,1例坏死行乙状结肠造口;2例回盲部和升结肠破裂行回肠造口;3~6个月再行造瘘吻合回纳。本组病例2例十二指肠破裂引流好转出院,其他均治愈。结论对迟发表现的胃肠道创伤病变应详细追问病史、连续动态观察、全面体检、合理辅助检查可较早发现并诊断此类损伤,及时手术可获得较好治疗效果。

Objective To summarize the diagnosis and treatment of gastrointestinal trauma with delayed expressions and improve the understanding and treatment of this kind of injury.Methods Totally 17 cases of gastrointestinal injury with delayed expressions from Oct.2014 to May 2018 were treated in the First Affiliated Hospital of Army Medical University.There were 13 males and 4 females;aged 17 to 58 years,with an average age of 39.3 years;there were 9 cases of traffic injuries,5 cases of falling injuries,2 cases of bruises,and 1 case of smash injuries.Exploratory laparotomy was performed and the diagnosis was confirmed after continuous dynamic observation,comprehensive physical examination and reasonable auxiliary examination.Treatment:anastomosis was performed for small intestinal and gastric trauma,fistula was performed for colon injury,and anastomosis was performed for the second stage.Results Partially resection and repair was performed in 2 cases of contusion necrosis on gastric wall,drainage and jejunostomy fistula in 2 cases of duodenal rupture,partial intestinal segment resection and end anastomosis in 5 cases of small intestine rupture and necrosis,and fistula was conducted in 1 case of ileum rupture.Partial necrosis resection and proximal fistula was conducted in 2 cases of transverse colon necrosis,sigmoid colostomy and fistula in 2 cases of sigmoid colon rupture and 1 case of necrosis;ileostomy and fistula in 2 cases of ileus and calcaneal rupture,and anastomosis were performed after 3-6 months.Two cases of duodenal rupture were improved and discharged,and the others were improved or cured.Conclusion For gastrointestinal trauma with late manifestations,detailed history,continuous dynamic observation,comprehensive physical examination,and reasonable auxiliary examination can be used to detect and diagnose such injuries earlier.Timely operation can obtain better therapeutic effect.