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。

Characteristic of traumatic colon injury and the experience of diagnosis and treatment

Objective To summarize the characteristic of traumatic colon injury and discuss the experience of diagnosis and treatment.Methods The clinical data of 48 cases of traumatic colon injury from 1995 to 2003 were retrospectively analyzed.Results Of 48 cases,71% were injured by stab,25% by contuse,and 4% by firearm.Thirty-five cases were complicated by multiple organ injuries.One stage repair or anastomosis after excision of colon injury were performed in 46 cases.In all cases,one case died in operation,one case was misdiagnosed in operation and died,and another 2 cases died from serious multiple organ injuries after operation.Seven patients were complicated with incision infection and 3 cases with serious abdominal infection.Conclusion Colon injury was mostly caused by abdominal puncture,always complicated by multiple organ injuries,and easily misdiagnosed.We emphasize early operation and comprehensive exploration of abdominal.One stage repair or anastomosis after excision of colon injury is recommended for most patients with colon injury.