腹部闭合性损伤小肠破裂的早期诊断及手术治疗

目的 探讨腹部闭合性损伤小肠破裂的诊断及手术治疗。方法 回顾性分析78腹部闭合性损伤小肠破裂的诊断方法及手术治疗结果，术后均联合应用抗生素防治感染。结果 诊断性腹腔穿刺、腹透的阳性率分别为89.7％、32.0%;30.7％的患者合并其他器官损伤；58例（74.4％）行单纯修补术，18例（23.1％）行肠部分切除吻合术。2例（2.5％）行断端修整吻合术。4例因迟发性小肠破裂再次手术治疗。本组死亡3例，死因为多器官功能障碍综合征（MODS）。结论 性腹腔穿刺在闭合性小肠破裂早期诊断中具有重要作用；术式选择宜根据术中情况灵活掌握；围手术期抗生素的正确应用对减少术后迸发症至关重要。

Early diagnosis and surgical treatment for closed rupture of small intestine

Objective To explore the diagnosis and surgical treatment for rupture of small intestine.Methods Diagnostic methods and surgical treartment of 78 closed rupture of small intestine were analyzed retrospectively.Results The positive rates of abdominal puncture and abdominal X ray were 89.7% and 32.0%,respectively 30.7% cases were complicated with other organs injured.All the patients were performed on the surgical operation,among which repairment for the small intestine rupture was performed in 58 cases(74.4%),partial resection of small intestine was performed in 18 cases (23.1%) and anastomsis of small intestine performed in 2 cases (2.5%).4 cases were reoperated because of delayed rupture of small intestine.3 cases died of MODS.Conclusion Diagnostic abdominal puncture plays an important role in the early diagnosis of closed rupture of small intestine.The selection of operative method is based on the degree of rupture.Suitable application of antibiotics is the key to reducing the complications.