腹腔镜诊断性腹腔灌洗对腹部刀刺伤的临床诊断

目的 评估联合使用腹腔镜诊断性腹腔灌洗对腹部刀刺伤的临床诊断价值. 方法 对2005年3月- 2010年6月21例腹部及胸腹联合区刀刺伤患者进行回顾性研究.所有患者先接受腔镜探查,如探查中未发现明确脏器损伤,则经套管针注入等渗盐水灌洗腹腔,并对灌洗液中RBC、WBC、胰淀粉酶(AMY)、胆汁成分行常规诊断分析. 结果 腔镜探查阳性5例,其中膈肌损伤2例,肝包膜外伤出血1例,小肠穿孔1例,胃壁穿孔1例.腔镜探查阴性16例,其中2例经腹腔灌洗检查后转开腹探查证实为小肠穿孔,并行肠修补术.手术时间(120.0±35.6)min,住院时间(5.3±3.4)d,无术后并发症. 结论 腹腔镜诊断性腹腔灌洗术将腹腔镜可视化特点与腹腔灌洗术高敏感性和特异性的优势相结合,能够有效运用于临床腹部刀刺伤的伤情诊断.     

心脏等多脏器刀刺伤1例诊治体会

报告1例刀刺伤致患者心、左肺、肝、右侧膈肌破裂的成功诊治经验,讨论心脏刀刺伤合并其他脏器损伤的诊断、救治方法及注意事项。     

腹部刀刺伤193例诊治体会

腹部刀刺伤是普通外科常见的急腹症,近年来发生率有明显增高的趋势。我院自1996年4月～2004年12月共收治腹部刀刺伤患者193例,现报告如下。1临床资料本组共193例,男179例,女14例。其中,他伤185例,自伤8例;年龄16～57岁,平均24.5岁。伤后入院时间最短为0.5h,最长为18h。伤口长约0.5～5cm。处理:迅速建立静脉通道,维持生命体征的稳定;对所有伤道均以手指或探针探查;未入腹腔的伤口给予清创缝合术;可疑患者均行诊断性腹腔穿刺及腹部B超或CT检查。对腹穿阳性、B超或CT检查有腹腔脏器损伤、腹腔积血行急诊手术探查;行胃部分切除术3例,胆囊切除…     

胸部刀刺伤62例救治体会

胸部刀刺伤因创口小，伤道深，极易损伤重要脏器，可发生严重并发症。如发现不及时延误诊治，可危及生命。因此，及时准确判断伤情，采取正确的治疗方法，是救治胸部刀刺伤的关键。1996年1月～2005年12月，我们共救治胸部刀刺伤62例，疗效满意。现分析报告如下。     

急诊电视胸腔镜诊治刀刺伤所致血气胸

目的 探讨急诊应用胸腔镜诊治胸部刀刺伤所致血气胸的手术方法及其优势.方法 分析对21例胸部刀刺伤所致的血气胸行急诊电视胸腔镜探查手术.结果 全组内镜或小切口下缝合肺裂伤23例次,肋间血管出血止血17例次,扩大心包切口并缝合损伤心肌1例次.单纯膈肌损伤修补2例次,合并腹腔脏器损伤经小切口下止血或修补4例次.手术操作时间平均单侧45.6分钟,双侧110.5分钟.本组无手术死亡,无胸部严重并发症发生.术后胸引流管平均拔管时间为2.2天,单纯血气胸术后平均5.8天出院.随访生活质量良好.结论 电视胸腔镜手术是诊断和治疗刀刺伤所致血气胸的一种有效的方法.     

腹部刀刺伤保守治疗临床分析

腹部刀刺伤在腹部创伤中是最常见的创伤类型之一,腹部刀刺伤往往伤情严重且复杂,大部分患者需要剖腹探查;但也有一些患者在严密的临床监测下可以保守治疗,从而避免不必要的手术对患者造成的损伤.笔者回顾性分析我院2004-2011年收治的腹部刀刺伤患者113例,其中保守治疗36例.现报告如下.     

胸部刀刺伤后膈肌损伤的胸腔镜探查诊治

目的 探讨胸腔镜诊断治疗胸腹部刀刺伤所致膈肌损伤的效果.方法 回顾性研究2000年4月-2011年10月68例胸腔镜探查术诊治的胸腹部刀刺伤所致膈肌损伤患者.结果 胸腔镜探查术发现11例隐匿性膈肌损伤,其中7例经胸腔镜直接修补后5例需同期剖腹探查腹腔脏器损伤.68例中,15例出现肺组织切割伤并通过胸腔镜修补或切除,13例清除凝固性血胸.术后并发症发生仅残留胸腔积液1例,肺炎2例,肺不张1例.住院时间(7.9±13.5)d,无ICU停留,引流时间(3.3±1.5)d,手术时间(45.6±78.1)min,术中出血量(57.8±24.3)ml.无中转开胸患者.术后6个月复查胸部CT未发现膈疝.本组患者胸腔镜探查膈肌损伤诊断率为100％.结论 对于血流动力学稳定的胸腹部刀刺伤应积极行胸腔镜探查,尤其是刀刺伤位于第7～9肋间患者行胸腔镜探查具有明确的膈肌损伤诊断和治疗意义.     

多发伤后严重腹腔感染42例报道

目的腹腔感染是多发伤后常见并发症,临床诊治难度大,本文探讨其发生机制及诊治方法。方法回顾性分析我院2005年7月～2009年3月间收治多发伤中发生严重腹腔感染的42例患者,男性31例,女性11例;年龄18～71岁,平均38.46岁;道路交通伤29例,高处坠落伤9例,刀刺伤4例。38例伤后经当地医院紧急治疗,于伤后2～55天转至我院,其中18例有伤后剖腹探查手术史;另4例直接入我院。经体格检查、腹腔穿刺、腹部超声或CT等检查确诊。行腹腔脓肿穿刺置管引流5例次、腹腔脓肿剖腹手术引流15例次、肠管损伤外置或造口18例次、坏疽胆囊切除4例次、坏死肝组织清除5例次、腹部切口负压封闭引流12例次、腹部切口负压封闭辅助关闭4例次。结果在入院后24小时内确诊并确定性治疗18例,24～48小时内9例,2～7天内6例,8～21天内9例。腹腔感染及远隔部位的感染包括切口感染6例、大腿脓肿1例、腹膜后脓肿3例、腹腔内脓肿3例、肺部感染5例。腹部损伤相关的其他并发症发生8例次,包括肺梗塞1例、应激性溃疡2例、胸腔积液5例。除1例药物依赖者刀刺伤后2个月死亡,其余并发腹腔感染的伤者均痊愈出院。结论腹腔感染与漏诊肠道损伤、首次手术处理不当以及伤后就诊较晚等有关,应严密观察腹部临床表现,反复腹腔穿刺、CT检查等以明确诊断,积极手术处理腹腔感染灶、引流脓肿。对于脓毒症恶化持续加重的患者应多方寻求证据,必要时果断剖腹探查。     

严重胰腺损伤22例

严重胰腺损伤多因上腹部钝性暴力撞击或挤压所致 ,常合并其他脏器的损伤 ,诊断与治疗均十分困难 ,术后并发症多 ,死亡率高。笔者结合我科 1981～2 0 0 1年收治的 2 2例严重胰腺损伤的诊治情况进行分析讨论。临　床　资　料1.一般资料 :男 2 1例 ,女 1例 ;年龄2 4～ 48岁 ,平均 3 4岁。致伤原因 :交通伤、挤压伤等 (闭合性损伤 ) 2 1例 ,刀刺伤 (开放性损伤 ) 1例。均合并腹部其他脏器和组织的损伤。其中 6例伴血气胸 ,3例伴膈肌破裂 ,2例伴多根肋骨骨折。胰腺损伤部位及程度 :按器官损伤分级 (ＯＩＳ)分级标准[1 ] :本组 2 2例胰腺损伤中Ⅱ…     

战时腹部外伤的急救及护理观察要点

腹部外伤,在战时是较为常见的严重创伤,其发生率为5%～8%,多见于火器伤、刀刺伤等.根据腹膜是否与外界相通,分为开放性和闭合性损伤两类.开放伤,战时最多见,如贯通伤,则有入口和出口,盲管伤只有入口没有出口.开放伤又可分为穿透伤和非穿透伤两类,前是指腹膜已经穿通,多数伴有腹腔内脏器损伤,后是腹膜仍然完整,腹腔未与外界交通,但也有可能损伤腹腔内脏器.     

Successfully treated bizarre self-mutilation with disembowelment – Case report with review of literature

Self-inflicted abdominal stab wounds are generally uncommon and there is no published report of survivors after extensive self inflicted disembowelment with mutilation. Here we present a case of 28 year old male who was brought to hospital 2 1/2 h after disembowelment through self inflicted abdominal stab injuries. The patient had hypovolemic shock due to bleeding from the mesentery and a 450 cm segment of small bowel which had been pulled out from 2 abdominal stab wounds and slashed multiple times by him. He had alcohol intoxication and hallucinations and did not seem to be in pain or emotionally affected by the severe injury. After resuscitation, and emergency resection with anastomosis he had an uneventful post-operative recovery. On psychiatric evaluation during follow-up, he was found to have schizophrenia aggravated by alcohol abuse and was treated accordingly. As self mutilation can be the first presentation of a psychotic episode, a psychiatric evaluation is necessary for all patients with self inflicted injuries.     

腹部刺伤时腹腔器官刺伤点数的临床意义

目的探讨腹部刺伤后剖腹探查时,如何避免遗漏刺伤点病灶。方法回顾性分析279例腹壁穿透伤,经剖腹探查分析腹腔器官刺伤点数目。结果279例剖腹探查结果的奇数刺伤点2111例,占75.6%;无刺伤48例,占17.2%;偶数刺伤点为20例,占7.2%。奇数刺伤点与无刺伤、偶数比较,差异有统计学意义(P<0.01)。由于再次剖腹探查证实,无刺伤有13例遗漏,偶数刺伤点有11例遗漏。所以真正的奇数点为235例,发生率为84.2%。结论腹部刺伤时腹腔器官刺伤点数多为奇数,如果剖腹探查者为偶数或为无刺伤时,应想到还有一个隐蔽的刺伤点尚未发现;此时应进一步详尽探查,以防遗漏刺伤点病灶酿成严重后果。     

Suicide by sharp instruments: A case of harakiri

A case of suicide by harakiri is described. The position of the subject, the absence of the shirt and the abdominal L-shaped cut agreed well with the formal procedure of harakiri. The characteristics of the stab wounds present on the right-hand side of the neck confirmed the assumption of self-infliction and excluded, from a legal point of view, murder by consent.     

The diagnosis of a murder from skeletal remains: a case report

A skeletonised body was found in a Danish forest. The examination of the bones revealed several incisions on the skeleton, one located on the cervical column, two on the sternum, one perforating incision to the right iliac crest, and several superficial ones to the ribs and the right tibia. The skeletonized body was thought to be that of a young man in the twenties with a height of 170 cm. It was estimated that the body had been lying at the spot for at least 1 or 2 y and had been murdered by several stab wounds to the chest and abdomen. Police enquiries subsequently revealed that the deceased was a 23-year-old male with a height of 171 cm. A man confessed to having murdered the victim 11/2 years earlier with several stab wounds to the face/neck, chest, abdominal wall and thigh. Received: 20 February 1996 / Received in revised form: 23 December 1996     

Stab wounds to the neck: role of angiography

Angiographic findings in 61 stab wounds to the neck were correlated with specific clinical findings. Eighteen of the stab wounds were associated with one or more major physical findings that included (a) pulse deficit, (b) active bleeding or expanding hematoma, (c) bruit or murmur, (d) neurologic deficit, or (e) hypotension. Of these 18 wounds, only two involved significant vascular injuries. The other 43 stab wounds were associated with minor physical findings, with the only indications for angiography being nonexpanding hematoma or proximity of trauma to major vessels. None of these 43 wounds involved significant vascular injury.     

Radiological stab wound channel depiction with instillation of contrast medium

The radiological depiction of stab wounds in soft-tissues using multislice computed tomography is difficult and the hereby obtained images often lack contrast. To overcome these shortcomings we tried a new method.We gently instilled the contrast medium Lipiodol^® Ultra-fluide into five experimentally induced stab wounds on a pork haunch. Subsequent MSCT reconstructions of the wounds delivered clear, for medical laymen easily appreciable images regarding the stab direction and the stab depth.We believe that this easy and rapid technique can be useful in the examination of stab wounds in living and dead victims of sharp trauma.     

Skin tension and cleavage lines (Langer’s lines) causing distortion of ante- and postmortem wound morphology

The assessment of individual wounds at autopsy may be complicated by the superimposition of a number of injuries or damage to tissues that occurred after death, either of which has the potential to distort the morphology of the initial injury. Additional factors that may change the shape of wounds are (1) the relationship of the wound to the so-called skin cleavage lines (Langers lines) and (2) tension placed on the skin. Three autopsy cases are reported to demonstrate once more how wound morphology may be altered by such factors. In case 1, rectangular stab wounds to the base of the neck in a 53-year-old man, which suggested that a square or rectangular tool may have caused the injuries, were altered to more typical knife stab wounds once skin tension had been released at autopsy. The uppermost wounds, however, continued to gape due to the effects of skin cleavage lines. In case 2, slit-like wounds resembling stab wounds in the neck of a 54-year-old woman found in a river were shown to be circular once skin tension had been released. In case 3, the effects of either cleavage lines or skin tension could be demonstrated on excised wounds from a 43-year-old man whose body had also been found in a river; tensile forces easily changed circular into slit-like wounds. Tension and/or skin cleavage lines may transform round skin defects into slit-like wounds resembling knife stab wounds, round out genuine stab wounds and artefactually lengthen stab wounds. These factors must be taken into consideration carefully when wounds are assessed at the death scene prior to autopsy.*Dedicated to Prof. Dr. Dr. Bernd Brinkmann on the occasion of his 65th birthday     

Characteristics and outcomes of homicidal and accidental stab wounds in emergency hospitals: A medicolegal comparative study

Differentiation between the various manner of stab cases is challenging in forensic medicine. Although the distinction between homicidal and suicidal stabbing is well defined, there is a lack of discrimination between accidental and homicidal cases. Therefore, this study aimed to assess the characteristics of and outcomes for stab patients admitted to multiple emergency hospitals to highlight the distinction between accidental and homicidal stab wounds. This prospective cohort study assessed all patients with stab wounds admitted to multiple emergency hospitals from February 2021 to October 2021. Data collected on admission were demographics, trauma circumstances, internal organ damage, and patients' outcomes. Afterward, patients were categorized into homicidal or accidental stabs. Most of the included 51 stab cases were homicidal (78.4%). Most homicidal stabs were in middle-aged male drivers; were caused by sharp weapons, such as a penknife; and occurred in fights outdoors during the summer daytime. In contrast, most accidental stabs were occupational among building carpenters. Although homicidal stab wounds were significantly associated with a regular elliptical shape, oblique orientation, and defense wounds, the existence of a regular elliptical wound shape increased the likelihood of a homicidal stab. Additionally, penetrating stab type and a higher Injury Severity Score (ISS) were the dominant predictors of complications and mortality in stab patients, respectively. For fatal vague stab cases scenarios, the presence of an elliptical wound suggests the probability of homicidal injury than accidental. The initial ISS and stab wound type should be assessed to stratify stab patients who need intensive management in emergency hospitals.     

Retrospective study on suicidal cases by sharp force injuries

A total of 65 suicidal cases due to sharp force injuries (cut and/or stab wounds) were investigated. Suicide by sharp force injuries accounted for 2.5% of all suicides in our prefecture during 1995-2005. The 65 victims were composed of 49 males and 16 females, and the age range of 50-70 years was most common. A history of psychiatric disease was found in 11 victims, and depression was the most common disease followed by schizophrenia. Of 65 cases, 8 victims had a history of previously attempting suicide. In 41 cases, a suicide note or will was found. Forty-six cases had pleural sharp force injuries. Interestingly, the remaining 19 deaths were due to a single sharp injury. Cutting injuries were predominantly located at the flexor side of the wrist (11 cases, 38%), followed by the neck (10 cases, 34%). On the other hand, stab wounds were most commonly located in the chest (17 cases, 49%). Tentative wounds, which were superficial cut wounds or stab wounds, were present in 37 cases (57%). In 27 of 37, hesitation marks were observed in close proximity. Tentative wounds more frequently appeared in cut injuries than in stab injuries. Of 28 cases with fatal cut or stab wounds localized in the trunk, 11 cases (39%) had clothing damage. In the discrimination between suicide and homicide, forensic pathologists should obtain information on victims and witnesses as well as investigating the scene and postmortem examination of the victim.