57例小肠损伤的诊断与治疗

目的探讨小肠损伤的诊断与治疗方法。方法收集江苏省人民医院溧阳分院普外科2008—2017年收治的小肠损伤57例,其中男性50例,女性7例;年龄22~87岁,平均51岁。外伤性小肠损伤多见于中年男性,其中道路交通伤23例(44.23%),钝器伤10例(19.23%),坠落伤8例(15.38%),锐器伤6例(11.53%),重物砸伤5例(9.61%),其他不明原因5例(9.61%)。探查发现受伤部位位于空肠28例(49.12%),位于回肠29例(50.87%)。剖腹探查指征:腹腔穿刺抽出脓性液体或者不凝血,CT或X线发现腹腔游离气体,部分患者血流动力学不稳定,进行性加重的腹痛持续无缓解,出现腹膜刺激征,考虑空腔脏器或者实质性脏器受损。根据受损部位及受损程度选择小肠修补术46例(80.70%)和小肠部分切除+吻合术11例(19.30%)。结果 57例中共出现并发症10例。采用逐步Logistic回归,以预后为因变量,其他因素为自变量,结果显示失血量为术后并发症的影响因素。失血量越多,预后越差(OR值为8.625)。结论小肠损伤多见于交通事故、击打、坠落等暴力致伤因素。术后相关并发症可能与失血量有关,提示在处理小肠损伤时提高诊断成功率、缩短患者接受手术时间,可减少术后并发症的发生。

Diagnosis and treatment of intestinal injuries

Objective To discuss the diagnosis and treatment methods for intestinal injuries.Methods 57 patients with intestinal injuries admitted to General Surgery Department of Liyang People`s Hospital from 2008 to 2017,were collected for retrospective analysis.Traumatic small intestinal injuries were often presented in middle-aged men.Among the patients,there were 23 caused by traffic accidents(44.23％),10 by blunt injury(19.23％) and 8 by falling accidents(15.38％),6 by sharp injuries (11.53％),5 by bruise (9.61％),5 by other unknown reasons (9.61％).The study revealed that 28 cases (49.12％) of the injuries were located in the jejunum,and 29 cases (50.87％) were located in the ileum.Purulent liquid or non-condensable blood could be found by abdominocentesis and free intraperitoneal air could be found by CT or X-ray.If progressively aggravating abdominal pain was sustainable and could be relieved,intestinal injuries should be considered.These patients might have injured hollow organ or substantial viscera injury.Intestinal repair was selected in 46 cases (80.70％) and small intestine ablation in combination with anastomosis was selected 11 in cases (19.30％) based on damaged parts and damage degree.Results Ten patients among 57 patients developed complications.Gradual Logistic Regression was used to analyze the prognosis of these patients.Results showed that blood loss volume was the influence factor of postoperative complications(OR=8.625).Conclusion Intestinal injuries were often caused by violent factors,such as traffic accidents.Relevant complications might be related to blood loss volume,indicating that when disposing intestinal injuries,improvement of intestinal injury diagnosis probability and reduction of operation time of patients can reduce occurrence of postoperative complications.