腹部损伤__

腹部穿透伤伴网膜、肠管脱出的治疗方法探讨

http://www.100md.com 《创伤外科杂志》 2005年第3期

腹部损伤,,腹部损伤；穿透伤；肠管脱出；剖腹探查；腹腔镜,临床资料,1一般资料,2治疗方法,3数据处理,结果,讨论,1腹部穿透伤网膜、肠管脱出的剖腹探查

     摘要：目的探讨腹部穿透伤网膜、肠管脱出的诊治方法。方法回顾性分析近10年来收治的86例网膜、肠管脱出且血流动力学稳定的腹部穿透伤病人的临床资料。按首次治疗方法分为3组：有剖腹指征立即行剖腹探查44例(组Ⅰ)；无剖腹指征行保守治疗16例(组Ⅱ)；腹腔镜诊治26例(组Ⅲ)。结果组Ⅰ发现脏器损伤36例，阴性剖腹8例；组Ⅱ保守治疗成功12例，中转剖腹4例，但其中1例为阴性剖腹；组Ⅲ腹腔镜探查阴性6例，腹腔镜手术处理损伤13例，中转剖腹7例。全组无腹内脏器损伤的比率为31.40%(27/86)。结论腹部穿透伤合并网膜、肠管脱出并不意味着腹内脏器损伤，剖腹探查会出现较高的阴性探查率，选择性保守治疗有一定的风险，采用腹腔镜处理是一种较好的诊治方法。

    关键词：腹部损伤；穿透伤；肠管脱出；剖腹探查；腹腔镜

    Treatment of penetrating abdominal injuries with omentum evisceration

    ZHU Mingde，FANG Chihua，CHEN Tiejun,et al.

    (Department of General Surgery,Zhujiang Hospital,South University of Medical Sciences,Guangzhou 510282,China)

    Abstract：Objective To investigate the treatment of penetrating abdominal injuries with omentum evisceration.Methods The clinical data of 86 patients of penetrating abdominal injury with omentum evisceration were studied.These 86 patients were divided into 3 groups: 44 cases operated immediately(group Ⅰ);16 cases treated conservatively(group Ⅱ);26 cases diagnosed and treated with laparoscopy(group Ⅲ).Results In group Ⅰ,negative laparotomy were found in 8 cases;In group Ⅱ,12 cases were treated with conservative approach successfully,and 4 cases were converted to laparotomy,1 case proved to be negative.In group Ⅲ,negative laparoscopy were found in 6 cases,13 cases were operated with laparoscopy,and 7 cases were converted to laparotomy.The patients without intraabdominal injuries accounted for 31.40%(27/86).Conclusion The isolated penetrating abdominal injury of the patients with omentum evisceration has a high rate of negative laparotomy.However the conservative approaches has some risk.The laparoscopic diagnosis and therapy is a good way to resolve this problem. ......

百拇医药网 http://www.100md.com/html/DirDu/2006/05/08/97/39/57.htm

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