CAJ | 학술논문

目的总结结直肠损伤的早期诊断和救治经验.方法回顾性分析2001年1月至2012年12月重庆市急救医疗中心收治的72例结直肠损伤患者的临床资料. 结果本组72例结直肠损伤患者的ISS评分平均为29 ±18；钝性伤45例,穿透伤27例；腹膜内结直肠伤57例,腹膜外直肠伤15例；入院时伴休克28例,合并多发伤69例.诊断:伤道探查13例,直肠指检3例,镜检1例,造影剂注入2例,剖腹探查53例.治疗:修补术46例,切除吻合术6例,结肠造口术18例,远、近端结扎2例.术后死亡5例,死亡组平均ISS评分43 ±7,死因为失血性休克3例,严重颅脑伤1例,术后全身炎症反应综合征和多器官功能不全综合征1例.存活者中与结直肠损伤相关并发症发生率为13％ (9/67),均治愈.结论早期诊断、及时手术是救治结直肠损伤成功的关键；准确把握一期手术适应证；对腹膜外直肠伤应分期手术.
목적 총결결직장손상적조기진단화구치경험.방법 회고성분석2001년1월지2012년12월중경시급구의료중심수치적72례결직장손상환자적림상자료. 결과 본조72례결직장손상환자적ISS평분평균위29 ±18；둔성상45례,천투상27례；복막내결직장상57례,복막외직장상15례；입원시반휴극28례,합병다발상69례.진단:상도탐사13례,직장지검3례,경검1례,조영제주입2례,부복탐사53례.치료:수보술46례,절제문합술6례,결장조구술18례,원、근단결찰2례.술후사망5례,사망조평균ISS평분43 ±7,사인위실혈성휴극3례,엄중로뇌상1례,술후전신염증반응종합정화다기관공능불전종합정1례.존활자중여결직장손상상관병발증발생솔위13％ (9/67),균치유.결론 조기진단、급시수술시구치결직장손상성공적관건；준학파악일기수술괄응증；대복막외직장상응분기수술.
Objective To assess early diagnosis and treatment experience of colorectal injuries.Methods We retrospectively analyzed the clinical data of 72 patients with colorectal injuries in January 2001 to December 2001.Results In this group of 72 cases,ISS score was 29 ± 18.Forty-five suffered from blunt injuries,27 cases from penetrating wounds,Peritoneal colorectal injuries in 57 cases,extraperitoneal rectal injury in 15 cases.Hemorrhagic shock existed in 28 patients at admission.69 were with multiple injuries.Diagnosis:injury tract probing in 13 cases,digital rectal inspection in 3 cases,microscopy in 1 case,the contrast examination in 2 cases,laparotomy in 53 cases.Treatment:repairment in 46 cases,injuried bowel excision anastomosis in 6 cases,18 cases underwent colostomy.5 cases died postoperatively with ISS score of 43 ± 7,among those 3 cases died of uncontrolled hemorrhagic shock,one of severe craniocerebral injury,one of postoperative SIRS and MODS.Other nonlethal postoperative complications occurred in 13％ (9/67),all were cured.Conclusions Early diagnosis and emergency operation is the key to successful treatment for colorectal injuries.The indication of one stage operation should be strict and accurate.Staged operation should be adopted in cases of extra-abdominal rectal injury.