创伤性结肠损伤42例分析

目的：探讨创伤性结肠损伤的特点以及诊断和治疗方法，提高早期确诊率和治疗成功率。方法：对1996～2003年期间42例结肠损伤病人的临床资料进行回顾性分析。结果：42例均行手术治疗，治愈41例，死亡1例。一期手术治疗31例，术后发生肠瘘及腹腔脓肿1例，腹腔感染脓肿形成1例，切口感染1例，并发症发生率为9．7％。治愈31例，治愈率100％。二期手术11例，首次术后发生腹腔感染2例，并发症发生率为18．2％，治愈10例，死亡1例。结论：结肠损伤一期手术治疗是一种理想可行的手术方法，但必须严格掌握其适应证；而早期确诊和控制感染可提高治疗效果。     

46例结肠损伤的外科治疗

目的:分析结肠损伤的特点,探讨结肠损伤的最佳治疗方案,提高早期确诊率和治疗成功率。方法:均行手术治疗,其中一期修补或肠段切除吻合38例,一期修补同时行损伤之结肠外置、二期还纳5例,结肠局部切除 近端造口二期吻合3例。结果:术中术后死亡各1例,治愈率95%。切口感染3例,肠瘘1例(一期修补术后)。结论:结肠损伤常伴有其他脏器损伤,具有一定的隐匿性。强调早期手术,探查全面,防止遗漏,按损伤部位、范围、损伤后至治疗时相隔时间等不同具体情况采用不同的治疗方法。     

外伤性结肠破裂79例手术治疗分析

目的 探讨创伤性结肠损伤的处理方法以及一期手术的安全性和有效性.方法 外伤性结肠破裂患者86例,79例行急诊手术治疗,其中行单纯修补手术37例,结肠部分切除Ⅰ期吻合术29例,结肠造口13例.结果 本组病例合并多发伤患者50例,有5例患者因胸腹部严重复合伤、术后肠瘘、失血性休克等原因死亡,其余患者均痊愈出院.结论 外伤性结肠损伤一期手术对绝大多数结肠损伤是安全可靠的,值得临床应用.     

结肠损伤诊治体会(附27例报告)

目的探讨结肠损伤诊治经验。方法对1990~2004年收治的27例结肠损伤的临床资料作回顾性分折。结果闭合性损伤19例,开放性损伤6例,医源性损伤2例。其中多发伤或多脏器伤14例,合并休克3例。手术确诊21例,术前确诊6例。行一期修补或肠切除吻合术22例,结肠造瘘2例,修补外置1例。死亡2例(术中、术后各死亡1例),切口感染2例,肠瘘1例。结论早期诊断、及早手术、仔细探查、选择正确术式是结肠损伤治疗的关键。     

结肠损伤20例诊治体会

为总结结肠损伤的诊治经验,对2010-2012年我院收治的20例结肠损伤者的病例资料进行回顾性分析。结果显示,20例患者中,闭合性损伤15例．开放性损伤5例;多发伤或多脏器伤16例;合并休克10例;手术确诊16例,术前确诊4例;行一期修补或肠切除吻合术17例,结肠造口术3例;死亡2例（术中、术后各死亡1例）;切口感染2例,肠瘘1例。本组治愈率为90．0％。结果表明,早诊断、早手术、仔细探查、选择正确术式是治疗结肠损伤的关键。     

严重放射性肠损伤28例的综合治疗

目的：探讨严重放射性肠损伤的综合治疗。方法：回顾28例严重放射性肠损伤患者的临床表现，诊断，治疗方法。肠粘连狭窄患者14例行回肠部分切除术，1例行右半结肠切除术，3例行乙状结肠直肠上端切除术。7例肠瘘患者有4例一期行肠瘘切除2，例行乙状结肠造瘘术。结果本组无死亡病例，1例发生低位结肠漏，4例因原发肿瘤复发死亡，所有患者肠功能，营养状态明显改善。结论：严重放射性肠损伤应积极进行手术治疗，配合临床营养支持可获得满意疗效。     

结肠损伤诊治的经验和教训

目的:提高结肠损伤的早期诊断率和选择合适的治疗方法。方法:回顾性分析我院近十年来收治的30例结肠损伤患者的临床资料,进行经验总结。结果:全部手术治疗,治愈28例,死亡2例。致死原因为感染中毒性休克和多器官功能障碍综合征。结论:结肠损伤早期诊断和及时手术治疗是非常重要的,一期手术是非常实用的手术方法。     

结直肠损伤的特点和处理

目的 探讨结直肠损伤的特点和结肠损伤Ⅰ期修复的适应证以及直肠损伤和医源性结直肠损伤处理的特殊性。方法 总结分析1989年1月～2000年12月收治的结直肠损伤41例临床资料。结果 38例行急诊手术,术中出现并发症11例,占26.8％,2例术中损伤未发现以致形成直肠阴道瘘和腹膜后脓肿,1例结肠镜下息肉切除造成小穿孔在镜下用钛夹修补治愈。本组治愈39例,死亡2例,均死于严重的并发症。结论 了解结直肠损伤的特点,提高结直肠损伤的认识,掌握好结肠Ⅰ期修复手术的适应证、直肠损伤及医源性损伤处理的特殊性是减少结直肠损伤并发症,提高外科治疗效果的关键。     

医源性结直肠损伤的诊治分析

探讨医源性结直肠损伤科学、合理的处理方案。回顾性分析2004年1月—2012年12月收治的19例医源性结直肠损伤的病例资料。19例患者均行手术治疗,一期手术切除或修补17例(89.47%),其中2例(11.76%)发生切口感染,2例(11.76%)发生肠瘘,均为Ⅱ级损伤引起;二期乙状结肠造瘘及造瘘还纳术2例(10.53%)。所有患者均痊愈出院。重视医源性结直肠损伤的处理,严格掌握其适应证,对早期发现、污染轻的医源性结直肠损伤可行I期手术;发现较晚或污染较重的则考虑行结肠造瘘及II期造瘘还纳术。     

医源性胆管损伤的原因及处理

目的 探讨胆管损伤和狭窄的防治方法。方法 回顾性分析６６例胆囊切除（或伴）胆总管探查术发生胆管损伤及狭窄的原因和治疗。结果 １３例胆管损伤在发现并立即修复,其中１２例手术治愈,１例术后发生胆管狭窄。５３例胆管狭窄或胆漏在术后被诊断,其中４例行胆管对端吻合（术后均复发狭窄）;４４例行胆肠Ｒｏｕｘ－ｅｎ－Ｙ吻合,３６例吻合治愈;５例吻合口狭窄经再手术治愈。８例死亡（死亡胆漏感染５例,胆汁性肝硬化３例）     

大肠癌并发急性肠梗阻的外科治疗

目的 探讨大肠癌并发急性肠梗阻的外科治疗方法及效果。方法 回顾性分析l997年l0月～2002年10月76例大肠癌并发急性肠梗阻行急症手术治疗者的临床资料，其中右半结肠癌并梗阻23例，左半结肠癌和直肠并梗阻53例。结果 76例均行手术治疗，其中行～期切除吻合55例(右半结肠一期切除吻合l9例，左半结直肠一期切除吻合36例)。术后发生吻合口瘘2例，肺部感染2例，伤口感染6例，切口裂开l例，总并发症发生率为14.5％。除l例死于多器官功能衰竭外其它病例均通过非手术治疗治愈，随访统计l，3，5年生存率分别为98．3％，55％，38．5％。结论 一期切除吻合手术治疗大肠癌并肠梗阻是可行的，而合理地选择手术方式，正确的术中操作和围手术期处理对提高疗效，改善患者生活质量有所裨益。     

Factors affecting outcome in pancreatic trauma

Reported mortality from pancreatic trauma remains at approximately 20% and morbidity is about 33%. A recent series was reviewed to highlight unresolved problems associated with this injury. From 54 consecutive patients treated operatively for pancreatic trauma during a recent 7-year period, 44 patients were evaluated. Among these 44, six died and 12 developed fistulas and/or abscesses. Of those who died, four had colon injuries and two had duodenal injuries, one of whom had combined colon and duodenal injuries. Patients with colon injuries also had a higher incidence of intra-abdominal abscesses and fistulas. Indeed, colon injury currently may be the most significant factor causing morbidity and mortality in cases of pancreatic trauma. Despite improved management of duodenal injuries, morbidity and mortality rates for these patients also remain high. Twenty-six patients went into shock before the end of their operation, and all six deaths occurred in this group. The mean number of intra-abdominal associated organ injuries was 2.1 per patient; complications and deaths were directly related to these injuries.     

创伤性结肠损伤的特点及诊治体会

目的探讨创伤性结肠损伤的特点和救治体会。方法回顾分析我院1995年1月~2003年12月结肠外伤48例的临床资料。结果结肠损伤中刀刺伤占71%,腹部钝性伤占25%,火器伤4%。合并多发伤或多脏器伤35例,一期修补或切除吻合46例,结肠局部切除 近端造口2例,手术死亡1例,十二指肠损伤漏诊1例,术后死亡3例,切口感染及脂肪液化7例,严重腹腔感染3例。结论结肠损伤以开放性穿透性损伤为多见,常伴有其他脏器伤,且结肠损伤具有一定的隐匿性,易误诊、漏诊,引起严重感染,影响愈合。治疗上强调尽早手术,术中探查应全面仔细,谨防遗漏,一期修补或切除吻合对绝大多数结肠损伤是安全可靠的。     

结直肠损伤的手术治疗：附125例报告

目的:探讨结直肠损伤的手术治疗和围手术期处理。 方法:回顾性分析19年间收治的125例结直肠损伤患者的临床资料。结果:结肠和腹膜内直肠破裂69例中，初期缝合或切除吻合56例（81.16 %），行造口术11例，“损伤控制外科”术式2例。腹膜外直肠破裂18例中，14例行乙状结肠近端造口并骶前引流，4例一期修补未造口;其余38例非全层损伤患者，均做简单修补。全组死亡8例（6.40 %），6例术中、1例术后死于失血性休克，1例术后5 d死于胸腔感染。术后并发症包括局部感染6例、粘连性肠梗阻1例，均治愈。 结论:多数结肠和腹膜内直肠损伤可一期手术，应配合围手术期正确使用抗生素尤其甲硝唑。腹膜外直肠伤应分期手术，为阻断远端污染，应行乙状结肠近端造口而不选择襻式造口。     

Penetrating pancreatic injuries. Analysis of 103 consecutive cases

The optimal management of penetrating pancreatic injuries continues to be a matter of debate and controversy. The present study analyzes 103 consecutive patients with these wounds treated at a level I Trauma Center in a 14-year period (1975-1988). Twenty-seven patients died within 48 hours from extensive associated trauma (Abdominal Trauma Index [ATI] 46.7). The majority of the remaining 76 patients were treated by debridement and drainage. Nineteen patients with grade III injuries had distal pancreatectomy. Six patients with extensive combined pancreatoduodenal injuries had pancreatoduodenectomy. Pancreatoenteric anastomoses or duodenal diversion procedures rarely were used. Pancreatic complications included major fistulas in four patients (5%) and pancreatic abscess in nine patients (11%). Only one of the fistulas required subsequent fistulojejunostomy. Intra-abdominal abscesses occurred in 18 patients (23.6%), mostly in patients with associated colon injury (P less than 0.001). It is concluded that a conservative approach to penetrating pancreatic injuries yields optimal results and that associated colon injury is an important predeterminant for abscess formation.     

The atriocaval shunt. Facts and fiction.

During the past 11 years, 31 patients with major juxtahepatic venous injuries were treated with the atriocaval shunt. Penetrating injuries occurred in 27 patients (87%), and injuries from blunt trauma occurred in four patients. Shock was present on admission in 28 patients (90%). Resuscitative thoracotomy for cardiovascular collapse was required in 13 patients (42%). Juxtahepatic venous injuries included the vena cava in 23 patients (74%) and the hepatic veins alone in five patients (16%). One patient had an isolated portal venous injury, and two patients died before their vascular injuries could be delineated. Technical problems related to the shunt occurred in seven patients. Most were related to delays in placement or problems encountered in obtaining vascular control of the suprarenal vena cava. Major hepatic resection was performed in 11 patients (35%). Twenty-five patients died of their injuries. No patient survived who required resuscitative thoracotomy, hepatic resection, or when technical problems with the shunt occurred. Six patients (19%) survived and were discharged from the hospital. All sustained gunshot wounds to the retro-hepatic vena cava. Four of the six survivors had serious postoperative complications, but none were related to the shunt. Major juxtahepatic venous injuries are highly lethal. The atriocaval shunt will permit the salvage of some patients where other methods are not possible. Avoidance of delay and alternative shunting techniques that eliminate difficult maneuvers may improve survival in the future.     

Traumatic injuries to the portal vein: case study

BACKGROUND: Injuries to the portal vein are rare but devastating. Contemporary studies have debated the most effective management for this injury. The purpose of this case study was to provide an update on portal vein injury and add information regarding its management. METHODS: A retrospective review investigated the 10-year experience with portal vein injury in a level 1 trauma center. RESULTS: Of the 18,900 trauma patients (0.08%) evaluated during a 10-year period, 15 sustained injuries to the portal vein. All the injuries resulted from penetrating trauma, and the overall survival rate was 60% (9 of the 15 patients). Four patients died of exsanguination and two patients died later as a result of multisystem organ failure. Postoperative complications were common. Sepsis and wound infection were the most common postoperative complications, occurring in seven (78%) of the nine survivors. All the patients had associated nonvascular injuries, whereas 9 (60%) of the 15 had associated vascular injuries. Associated injuries to the other structures in the portal triad occurred in 7 (47%) of the 15 patients, and 5 (71%) of these patients survived. Survival rates by procedure were 86% for venorrhaphy and 67% for ligation. CONCLUSIONS: Injuries to the portal vein are rare. In this study, exsanguination was the main cause of death. The key to a favorable outcome is prompt control of hemorrhage with an early decision to proceed with either venorrhaphy or ligation. Ligation can be effective for the management of hemodynamically unstable patients.     

创伤性结肠损伤的处理

目的 探讨创伤性结肠损伤的诊断和处理方法,提高早期确诊率和治疗成功率,降低并发症和死亡率。方法 回顾性分析我院１９９３～１９９８年期间３２例结肠操作的临床资料。结果 早期确诊２４例（７５％）,误诊８例（２５％）。３２例结肠损伤中行单纯结肠一期缝合修补２４例,一期结肠切肠吻合５例,共２９例,一期手术率９０．６％。损伤肠段修补或切除加近端造瘘３例,造瘘率９．４％。并发症４例,占１３．８％;全组病例无死     

经腹腔镜结肠直肠癌切除术

目的：探讨电视腹腔镜手术在治疗结肠直肠癌中的应用、手术方法及临床效果。方法：利用腹腔镜技术对78例结肠直肠癌的患者进行手术,并对手术操作、并发症的出现及术后恢复等情况进行总结性分析。结果：78例患者采用电视腹腔镜方法完成手术,无因术后并发症而死亡的病例。经随访,1、3、5年生存者分别为21、17、8例;术后因肿瘤转移死亡11例,其他原因死亡2例;失访10例;余9例为术后不足1年时间的患者,除1例术后11个月发生肿瘤肝转移需行手术切除外,其他8例尚未见肿瘤的复发及转移。结论：只要掌握好腹腔镜的操作技巧及结肠直肠癌切除的手术指征,用腹腔镜的方法治疗结肠直肠癌不但是可行的,而且具有广阔的前景。