鲍　威　王浩伟　张　鼎　朱动传

【摘要】 目的 探讨外伤性小肠破裂的诊断与治疗。方法 分析总结本院从1996-2006年间收治的85例外伤性小肠破裂患者的临床资料。结果 分析85例小肠破裂的临床症状体征和实验室改变，确定诊断的依据。单纯修补30例，肠部分切除49例，修补加肠减压6例，83例治愈，2例死亡。结论 临床症状、体征和必要的辅助检查资料对外伤性小肠破裂具有重要的意义。治疗以手术为主，单纯修补和肠部分切除是重要的治疗手段 。

【关键词】 外伤性;小肠破裂；诊断；治疗

Analysis of 85 cases of traumatic rupture of small intestine

BAO Wei,WANG Hao-wei,ZHANG Ding，et al.Department of General Surgery,Workers Hospital of Suining,Suining,Jiangsu 221200,China

【Abstract】 Objective To probe into the diagnosis and treatment of traumatic rupture of small intestine(TRSI).Methods There were 85 cases of TRSI who had undergone operation in our hospital were retrospectively received from 1996 to 2006.Results The materials of clinical symptoms,signs and lab detection of 85 cases of such patients were analyzed and diagnosis had obtained.The simple repair was underwent in 30 cases,partial intestinal resection and anastomosis was underwent in 49 cases and intestinal decompression was underwent in 6 cases.Of the 85 cases of TRSI,83 cases recovered smoothly after operation.2 cases died.Conclusion Clinical symptom and signs as well as the auxiliary diagnosis are very important for diagnosis of TRSI.The main treatment should be operated according to situation and simple repair or partial resection could be performed.

【Key words】 Traumatic;Rupture of intestine;Diagnosis;Treatment

外伤性小肠破裂虽在腹部损伤中较常见，由于缺乏特异性的诊断方法^[1],临床上延误诊断和处理不当仍时有发生，本院1996-2006年12月共手术治疗外伤性小肠破裂85例，均经手术证实，现就其诊治分析如下。

1 临床资料

1．1 一般资料 本组男67例，女18例，年龄15~70岁，其中20~50岁57例。损伤原因：闭合性损伤71例，占84%，其中交通事故钝器伤59例,坠落伤7例,疝强行回纳5例;开放性损伤14例，占16%，其中锐器刺伤10例，人流肠穿孔4例。并发其他脏器伤：骨折4例，胸外伤5例，脑外伤5例。受伤后入院时间：受伤后入院时间<1 h 10例，1~6 h 41例，6~12 h 29例，12~24 h 5例。由外院转来10例，直接来院75例。

1．2 临床表现 全组患者均有不同程度的腹痛(100%)恶心呕吐62例(72．8%)，腹膜刺激征61例(71%)，肠鸣音减弱或消失伴有休克16例(19%)，腹部B超检查53例，可疑腹腔积液28例(52．8%)，闭合性损伤中61例行腹腔穿刺，共穿刺72次，阳性49例(80%)。60例腹透发现膈下游离气体31例，阳性率(52%)。

2 治疗方法与结果

严密观察一般情况及腹部体征，禁食，迅速建立静脉通道，扩容、补充水电解质，使用抗生素预防感染。……