结肠损伤临床特点和手术疗效分析

目的:总结结肠损伤的临床特点和预后因素,探讨提高结肠损伤手术疗效的措施。方法:回顾性总结58例结肠损伤的住院资料、剖腹探查结果、手术类型和术后恢复情况,分析临床上采纳I期或Ⅱ期手术的标准和影响手术效果的关键步骤。结果:右半结肠损伤35例,左半结肠损伤17例,左右结肠均损伤6例,54例合并有腹腔多脏器或腹部以外的损伤。27例在8h内手术治疗,20例术前术中出现低血压超过1h。56例术前术中确诊,2例剖腹探查术后漏诊。总体手术治愈率87.9%(51/58),死亡率12.1%(7/58),合并症发生率25.5%(13/51)。I期结肠修补或吻合术治愈率90.6%(29/32),死亡率8.4%(3/32),合并症发生率20.7%(6/29);Ⅱ期吻合术治愈率84.6%(22/26),死亡率15.4%(4/26),合并症发生率31.8%(7/22)。结论:准确判断结肠损伤程度、全面了解合并损伤脏器、术中仔细探查、彻底的肠道和腹腔冲洗以及损伤部位严格的清创消毒,是I期手术也是Ⅱ期手术成功的关键。

Clinical Characteristics and Curative Effect of Operation for Colon Trauma

Objective:To summary the clinical characteristics, prognosis factors of colon trauma in order to improve the surgical management outcome of colonic trauma.Methods:Data of 58 patients with colon trauma were investigated retrospectively, including hospitalization, exploratory laparotomy, operation type and postoperative recovery. The criteria for I stage or II stage operation were analyzed and evaluation was given to the key steps which influenced curative effect of operation.Results:Injuries were found at right hemicolon in 35 cases, left hemicolon in 17 cases and bilateral colon in 6 cases. Multiple intro-abdominal or extro-abdominal injures were found in 58 caese. Exploratory laparotomy was performed within 8 hours after injure in 27 cases, and 20 cases had hypotension over 60 minutes pre-or intro-operation. Injures were confirmed in 56 cases during exploratory laparotomy, but injures were missed in 2 cases. The overall recovery rate of operation, mortality and complication rate was 87.9%(51/58), 12.1%(7/58) and 25.5%(13/51), respectively: 90.6%(29/32), 8.4%(3/32) and 20.7%(6/29), respectively, in I stage repair or anastomosis patients; 84.6%(22/26), 15.4%(4126) and 31.8%(7/22),respectively, in II stage anastomosis patients.Conclusion:It is the key to success for not only I stage but also II stage operation of colon trauma to judge accurately the trauma extent, appraise other organ injures, carefully explore during operation, thoroughly irrigate of peritoneal cavity and intestinal tract, strictly debride and sterilize.