腹部创伤手术后感染并发症48例分析

目的 腹部创伤手术后发生感染并发症的概率高,临床诊治难度大,本文探讨其发生机制及防治策略.方法 回顾性分析第三军医大学附属大坪医院在2005年7月- 2010年12月间收治的腹部创伤手术后发生腹部感染并发症的48例患者,其中男性30例,女性18例,平均年龄38岁；单纯腹部损伤20例,多发伤28例,ISS评分16 ～52...

Diagnosis and treatment of postoperative complicated abdominal infections in abdominal injuries

Objective Because of high incidence rate of complicated postoperative abdominal infections in abdominal injuries and difficulty in their clinical diagnosis and treatment,this article aimed to investigate the mechanism and the surgical tactics for this kind of complication.Methods Totally 48 abdominal-injured cases of postoperative complicated abdominal infections in our hospital from July 2005 to December 2010 were reviewed.These patients (Male 30,Female 18) aged 16-70 (mean 38) years.There were 20 cases of simple abdominal injuries,and 28 cases of multiple injuries ( ISS 16 - 52,mean 24.42).The complicated postoperative abdominal infections included abdominal incision infections (25cases),intra-abdominal infections( 18 cases) and retroperitoneal infections(5 cases).Forty cases were transferrted from other hospitals to our hospital 2 - 76 days after trauma.16 of which underwent exploratory laparotomy at other hospitals after injury,and 8 cases were directly transferred to our hospital after injury.Results All patients finally had a definite diagnosis by abdominal checking(26 cases),paracentesis(5 cases),ultrasound and CT scan ( 12 cases),and PET/CT scan (5 cases)in our hospital,and were confirmed by cultiure of pathogenic bacteria.The treatment included vacuum sealing drainage (VSD) (25 cases),percutaneous imaging- guided abdominal abscess drainage(13cases) and re-laparotomy ( 10 cases).Successfull treatment was achieved in 46 patients,death in 2 patients.The causes of death consisted of 1 case of severe craniocerebral injury,1 case of MODS.Conclusions Complicated abdominal infections often occurs after the operations of abdominal injuries.attentively abdominal checking,paracentesis,and CT scan repeatedly were proofs to benefit the finally diagnosis.VSD therapy is a simple and effective method for abdominal incision complication,and dynamic CT scan and prompt exploratory laparotomy can improve patients' prognosis.