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1.
目的探讨超声引导经皮置管引流在重症急性胰腺炎治疗中的应用价值。方法自2002年1月至2004年6月对9例重症急性胰腺炎采用了包括超声引导经皮置管引流在内的多种非手术治疗手段,其中对6例腹腔渗液较多者,实施超声引导下经皮穿刺置管引流和腹腔灌洗;对4例合并胰腺周围积液并感染者,实施超声引导下经皮穿刺置管引流。结果9例病人全部治愈,包括1例暴发性急性胰腺炎,无一例需手术治疗,腹腔引流管留置时间为5~7d,胰周引流管留置时间为7~60d(平均为30d),住院时间32~152d,平均68d。结论超声引导经皮置管引流对于重症急性胰腺炎腹腔积液较多者以及胰腺周围积液合并感染者能够进行简便、安全、有效的治疗,它的成功应用为非手术治疗重症急性胰腺炎提供了有益的经验。  相似文献   

2.
自体血回输抢救腹腔内大出血50例报告   总被引:2,自引:0,他引:2  
我院自1991年10月至2001年5月收治腹部闭合性损伤腹腔内大出血患者55例,其中50例在抢救中行自体血回输,取得满意效果.50例中男36例,女14例,年龄6.5~57岁,平均34岁.均在伤后0.5~24小时入院,42例伤后6小时入院.均行手术治疗,发现脾破裂37例,肝破裂11例,肝脾破裂2例; 伴肠系膜血管破裂2例,伴空腔脏器穿孔3例,伴肝胆管破裂2例.术中准备无菌回收瓶,插入输血漏斗,斗内置5层脱脂干纱布.集血盆中倒入生理盐水(血∶水=5∶1,加/不加抗凝剂),将采得的血倒入盆内,轻轻摇匀后,经漏斗滤入回收瓶.更换干纱布,重新过滤一次,然后直接回输.本组术中发现腹腔内出血量约600~4500 ml,平均1782 ml,无禁忌证者均行自体血回输.回输量400~3500 ml,平均1088 ml.50例患者抢救全部成功,无并发症发生.  相似文献   

3.
目的探讨应用一次性血液回输器在非体外循环下冠状动脉旁路移植(off-pump coronary artery bypass,OPCABG)术后回收自体引流血的临床效果。方法 2007年8月~2009年2月,我院连续对15例OPCABG患者在术后24小时内应用一次性密封血液回输装置收集心包引流血,并经滤膜滤过后把自体引流血回输体内。结果每个病例回输自体血量115~1350ml,平均562.4ml;回输自体血量占其引流血量的比例为27.8%~96.0%,平均45.5%;回输自体血量占总输血量27.1%~76.2%,平均46.0%。凝血酶原时间(PT)、凝血时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)术后即刻及术后24小时分别与术前比较,差异无显著性(P0.05)。术后均无输血反应,无凝血功能障碍,无新桥梗阻及血栓形成,全部按期出院。结论一次性回输器回收自体引流血回输在OPCABG术后的应用效果良好,未见不良反应及并发症。  相似文献   

4.
目的:探讨腹腔镜脾切除术(LS)联合术中自体血回输治疗外伤性脾破裂的安全性与可行性。方法:回顾分析2014年6月至2018年10月行LS联合术中自体血回输治疗38例Ⅱ级以上外伤性脾破裂患者的临床资料,分析术中自体血回输量、手术时间、术后住院时间、术后并发症等情况。结果:38例患者中Ⅱ级损伤6例(15.8%),Ⅲ级损伤25例(65.8%),Ⅳ级损伤7例(18.4%)。37例获得成功,1例中转开腹。自体血回输38例(100%),术中自体血回输量平均(1 260±335)mL,手术时间平均(135±50)min,术后平均住院(10±5)d。术后未出现大出血、胰瘘等严重并发症,仅1例术后少量出血,经引流对症治疗后痊愈出院。结论:LS联合自体血回输是治疗血流动力学稳定的外伤性脾破裂患者的有效措施,是安全、可靠的,值得临床推广应用。  相似文献   

5.
目的 探讨急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用的可行性。方法 38例腰椎滑脱行后路减压、椎弓根螺钉内固定加椎体间Cage融合术患者,随机分为三组,急性等容血液稀释结合术中自体血回输组(组Ⅰ,n=12);自体血回输组(组Ⅱ,n=12);对照组(组Ⅲ,n=14)。术中均采用控制性低血压,记录术前、术中、回输前、回输后、术后的血红蛋白和红细胞比容,分别记录回输的血量和输异体血量。结果 急性等容血液稀释结合术中自体血回输组术中输异体血量约100ml,自体血回输组输异体血量约400ml,对照组输异体血量约800ml,经统计学检验有显著差异(P<0.05)。结论急性等容血液稀释结合术中自体血回输在脊柱手术中临床应用是一种安全有效、节约血源的方法,可减少异体血输入,避免其并发症。  相似文献   

6.
目的总结彩超引导下经皮穿刺置管冲洗引流治疗腹腔脓肿的临床疗效。方法回顾性分析我院2003年1月至2013年3月期间对124例腹腔脓肿患者采取彩超引导下经皮穿刺置管冲洗引流治疗的临床资料。结果124例腹腔脓肿患者中治愈118例(95.2%);6例未治愈(4.8%),经手术治疗后痊愈。全组置管均顺利,未发生出血、腹腔脏器受损等严重并发症。间隔1~3个月来院复查B超,随访患者106例(85.5%),随访(7±2.43)个月未见复发。结论选择性采用彩超引导下经皮穿刺置管冲洗引流治疗腹腔脓肿微创、安全及有效。  相似文献   

7.
目的 探讨超声引导下经皮穿刺置管引流(PCD)在重症急性胰腺炎(SAP)继发腹腔感染中的应用价值.方法 对65例SAP继发腹腔感染患者行超声引导下PCD,根据感染情况留置1枚或多枚引流管,常规进行引流液细菌及真菌培养,依据药物敏感性试验结果应用抗生素.术后定期进行检查,对新增感染病灶再次或多次进行PCD,对症状加重者改行外科开放清创引流手术.结果 65例全部合并细菌感染,18例为复杂感染,其中10例合并真菌感染.23例通过单纯PCD治愈;其余42例接受外科清创引流手术治疗,术后38例痊愈,3例死于脓毒症导致的多器官功能障碍,1例死于感染所致的腹腔出血.穿刺置管后发生出血5例,胰瘘6例,经非手术治疗痊愈;无其他导管相关并发症.61例痊愈患者随访3个月至2年无感染复发.单纯PCD治愈率为 35.4%(23/65),病死率为 6.2%(4/65).结论 应用PCD技术治疗SAP继发腹腔感染是可行、安全和有效的.  相似文献   

8.
目的 探讨经皮经肝胆管穿刺引流(PTCD)、经皮腹腔穿刺引流及Roux-en-Y胆管空肠吻合术序贯治疗高位胆管损伤合并胆漏的疗效.方法 对我中心2004年5月至2009年5月期间收治的5例高位胆管损伤合并胆漏的患者,应用PTCD、经皮腹腔穿刺引流、Roux-en-Y胆管空肠吻合术序贯治疗过程及疗效进行回顾性分析.结果 5例患者均获痊愈,随访3~24个月,未发生胆管再次狭窄、胆管炎等并发症.结论 PTCD、经皮腹腔穿刺引流后,再进行Roux-en-Y胆管空肠吻合术是治疗高位胆管损伤合并胆漏的首选方法.  相似文献   

9.
超声引导下经皮肝穿刺诊治小儿肝脓肿(附15例报告)   总被引:1,自引:1,他引:0  
目的 探讨超声引导下经皮肝穿刺抽脓或置管引流在小儿细菌性肝脓肿的临床应用价值。方法对15例小儿肝脓肿通过超声引导确定后进行穿刺抽脓或置管引流,其中9例行穿刺抽脓1~4次,6例行置管引流。结果15例穿刺、置管全部获成功,治愈14例,住院15~42d,平均26.3d,无出血及胆漏并发症。11例随访4个月~1年,平均6.8月,均无复发。1例无效自动出院。结论超声引导经皮肝穿刺或置管引流治疗小儿肝脓肿是切实可行的办法。  相似文献   

10.
目的 总结自体血回输技术和腹腔镜技术相结合治疗外伤性脾破裂患者的诊治经验,进一步提高救治水平. 方法 对本院在2009年1月至2011年12月期间10例脾脏外伤患者在自体血回收输血下进行LS手术的患者进行回顾性分析,评估该法的效果和安全性. 结果 10例患者均在腹腔镜下完成手术,1例术中改行手助腹腔镜脾切除术;回输自体血200~1100ml,平均750ml;自体血液回输过程顺利,无明显凝血异常、血红蛋白尿及过敏反应等输血并发症;术后1-3天内肛门均恢复排气,平均2天开始进流质饮食,术后有2例发生左侧胸腔少量积液,其中1例并发左膈下积液,经保守治疗后痊愈;余无术后出血、门静脉栓形成、脾窝感染、左下肺不张及结肠胰腺损伤等并发症,全部病人临床痊愈出院,住院期间无并发症,平均住院日:13.6天. 结论 将自体血回输技术和腹腔镜技术相结合治疗外伤性脾破裂的患者,是切实有效安全的,在临床上值得广泛推广.  相似文献   

11.
Selective management of blunt splenic trauma   总被引:2,自引:0,他引:2  
During a recent 8-year period, 235 patients with documented blunt splenic trauma were treated. After exclusion of 39 patients with early deaths (19 dead on arrival, nine died in emergency room, and 11 died in operating room), the 196 remaining patients were treated in accordance with an evolving selective management program. Definitive management included splenectomy in 117 patients (59.7%), repair in 32 (16.3%), and nonoperative treatment in 47 (24%). A spectrum of blunt splenic trauma, as manifested by the degree of associated injuries (Injury Severity Scores), hemodynamic status, and blood transfusion requirements, was identified and permitted application of a rational selective management program that proved safe and effective for all age groups. Comparative analysis of the three methods of treatment demonstrated differences that were more a reflection of the overall magnitude of total bodily injury sustained rather than the specific manner in which any injured spleen was managed. Retrospective analysis of 19 nonoperative management failures enabled establishment of the following selection criteria for nonoperative management: absolute hemodynamic stability; minimal or lack of peritoneal findings; and maximal transfusion requirement of 2 units for the splenic injury. With operative management, splenorrhaphy is preferred, but it was often precluded by associated life-threatening injuries or by technical limitations. Of 42 attempted splenic repairs, ten (24%) were abandoned intraoperatively. There were no late failures of repair. In many cases of blunt splenic trauma, splenectomy still remains the most appropriate course of action.  相似文献   

12.
The nonoperative management of splenic injury secondary to blunt trauma in older patients remains controversial. We have reviewed our experience from January 1978 to December 1997 with selective nonoperative management of blunt splenic injury in adults 55 years and older. Criteria for nonoperative management included hemodynamic stability with any transient hypotension corrected using less than 2,000 cm3 crystalloid infusion, a negative abdominal physical examination ruling out associated injuries, and a blood transfusion requirement of no more than 2 units attributable to the splenic injury. During the study period, 18 patients over age 55 with radiographic confirmation of a splenic injury met the above criteria for nonoperative management. Their mean age was 72 years (range 56-86), and 13 of the 18 were female (72%). The mean Injury Severity Score was 15 (range 4-29), with the mechanism of injury equally divided between automobile crashes (9) and falls (9). During a similar time period, 15 patients 55 years or older with splenic injury composed an operative group; these patients did not differ with respect to age (mean 68 years), sex (60% female), or mechanism of injury. CT scans of 8 patients managed nonoperatively were available and graded using the American Association for the Surgery of Trauma classification, with a mean score of 2.3 (range 2-3). Eight of the 18 nonsurgical patients received blood transfusions. None of the 18 patients who met the criteria for nonoperative management "failed" the protocol, and none were taken to the operating room for abdominal exploration. Two patients (11%) died of associated thoracic injuries after lengthy hospital stays, one at 10 days and one at 24 days. We conclude from our data that nonoperative management of blunt splenic injury in patients age 55 years and older is indicated provided they are hemodynamically stable, do not require significant blood transfusion, and have no other associated abdominal injuries.  相似文献   

13.
Meguid AA  Bair HA  Howells GA  Bendick PJ  Kerr HH  Villalba MR 《The American surgeon》2003,69(3):238-42; discussion 242-3
Recent reports have shown an increased mortality associated with the nonoperative management of blunt splenic injury. We have prospectively applied criteria developed from our previous 15-year experience for the nonoperative management (NOM) of blunt splenic injury. These criteria consist of 1) hemodynamic stability on admission or after initial resuscitation with up to two liters of crystalloid infusion, 2) no physical findings or any associated injuries necessitating laparotomy, and 3) a transfusion requirement attributable to the splenic injury of 2 units or less. From 1994 through 2000 a total of 99 patients presented with blunt splenic injury. Thirty-one patients (31%) underwent splenectomy secondary to hemodynamic instability. During the observation period eight of the 68 patients (12%) who initially met criteria for NOM developed hemodynamic instability and underwent splenectomy. All NOM failures occurred within 72 hours of admission. There was no mortality associated with splenic injury in the NOM (Group I) or in the group failing NOM (Group II), and no associated morbidities from the splenic injury were seen in either group. No significant differences were seen between Groups I and II in terms of age, gender, mechanism of injury, Injury Severity Score, admitting systolic blood pressure, admitting hemoglobin, transfusion requirements, intensive care unit length of stay, or total hospital length of stay (all P > 0.200). We conclude that established criteria for intervention and careful observation in an intensive care setting for at least 72 hours will minimize morbidity or mortality associated with blunt splenic injury in adults.  相似文献   

14.
Selective nonoperative management of blunt splenic trauma in adults   总被引:2,自引:0,他引:2  
The use of selective nonoperative management of blunt splenic trauma in adults is based on the undeniable benefits of this approach in children. Proper patient selection requires hemodynamic stability, lack of generalized peritoneal irritation, and minimal blood transfusion needs. Computed tomography is now used to make the diagnosis, but the decision for laparotomy is based on clinical grounds. Forty-one (87%) of 47 patients selected for nonoperative management were treated successfully without laparotomy, while the remaining 6 patients underwent delayed operations for persistent splenic bleeding. Blood transfusion requirements were significantly less in the observed group than in the operative group for patients with isolated trauma and for patients with polytrauma. There were no known missed intra-abdominal injuries and no deaths with the nonoperative approach. Analysis of our results has confirmed that nonoperative management is a safe and effective alternative to immediate laparotomy in properly selected patients and it can result in splenic salvage without the need for an operation.  相似文献   

15.
闭合性腹部损伤脾破裂非手术治疗的探讨   总被引:33,自引:1,他引:32  
目的探讨闭合性腹部创伤脾破裂非手术治疗的可行性。方法对1995年1月至1997年3月间行手术和非手术治疗的32倒闭合性腹部创伤脾破裂患者的临床表现和治疗结果进行回顾性分析。结果脾破裂非手术治疗患者12例占同期脾破裂病例的37.5%(12/32),男10例,女2例,平均年龄35岁(16~50岁)。非手术组患者其损伤程度较手术组患者轻。非手术治疗失败1例,治疗成功率92%。平均住院日为16天,出院随访1~27个月未发现有并发症,其中10例随访3个月以上,其CT检查示脾脏损伤均已愈合。结论合适的选择脾破裂患者行非手术治疗是安全、有效的。  相似文献   

16.
The management of isolated blunt splenic trauma in adults is controversial. The authors present a series of 17 patients with blunt splenic trauma who were selected for nonoperative management. Only one patient eventually required surgery, for a ruptured spleen. Complications included pneumonia (two cases) and pleural effusion, atelectasis and ileus (one case each). There were no deaths. Five patients required transfusion, for a total of 17 units of blood. The mean length of hospital stay was 9.4 days. Comparison with a group of 17 patients treated operatively during the same period showed that those treated nonoperatively had fewer complications, required less blood and had a similar length of hospital stay. The authors conclude that nonoperative management of selected patients with isolated blunt splenic trauma is safe, if the patient's condition is closely monitored.  相似文献   

17.
Nonoperative management of blunt splenic injury has been infrequently selected for adults. Nonoperative management was initially utilized in seven adult patients (23%) with blunt splenic injury during a 6-year period. Two patients eventually failed nonoperative management and required surgical intervention. No morbidity or mortality has been recorded in the remaining five patients (16%) successfully followed after 32.6 months. No added morbidity was sustained by the two patients who failed nonoperative management during the delay of surgical intervention. Hospitalization was briefer in the nonoperative group. Our experience indicates that blunt splenic injury can be successfully nonoperatively managed in an adult population seen at a community hospital.  相似文献   

18.
Selective nonoperative management is appropriate for most blunt splenic injuries in adults and children, but the efficacy of this approach is unknown when injury occurs in patients with concurrent infectious mononucleosis. We have reviewed our experience during the past 23 years with the selective nonoperative management of blunt splenic injury in these patients. Medical record review identified nine patients with blunt splenic injury and infectious mononucleosis from 1978 to 2001, representing 3.3 per cent of our total trauma population with blunt splenic injury treated during that interval. Two patients underwent immediate splenectomy because of hemodynamic instability. Seven patients were admitted with the intent to treat nonoperatively. Five patients were successfully managed nonoperatively. Two patients failed nonoperative management and underwent splenectomy, one because of hemodynamic instability and one because of an infected splenic hematoma. Concurrent infectious mononucleosis does not preclude the successful nonoperative management of blunt splenic injury. This small subset of patients may be managed nonoperatively using the same criteria as for patients whose splenic injuries are not complicated by infectious mononucleosis.  相似文献   

19.
To address criticisms of nonoperative management of splenic injury, we hypothesized that (1) patients with minor splenic injuries have a lower risk of associated visceral damage than patients with splenic injuries in general, and (2) exploration of these patients does not decrease their blood requirements. We reviewed charts of 182 patients who suffered blunt splenic trauma between 1983 and 1988. Sixty-seven sustained minor injuries, defined as requiring no therapy or responding to topical hemostatic agents. Twenty-three were initially managed nonoperatively, with three subsequently explored surgically for falling hematocrit; no associated injury requiring therapy was found. The median transfusion requirement in these 23 patients was 2 units. Forty-four were immediately explored, 11 for readily diagnosed injuries mandating laparotomy. The other 33 were explored for hemoperitoneum. One had an unsuspected bowel injury. The median blood requirement in these 33 was 2.5 units. We conclude that patients with minor splenic injuries who have no other indication for laparotomy have a very low incidence of associated significant abdominal injury. Their transfusion requirements are also not reduced by exploration.  相似文献   

20.
The treatment of blunt splenic injury has evolved over time from splenectomy in all patients to nonoperative management in stable patients with operation reserved for failures of NOM. While rates of OPSI remain low in trauma patients, splenic salvage in stable patients should be attempted. However, clinical evidence of ongoing blood loss or instability should be addressed with prompt splenectomy. Careful patient selection is of paramount importance in nonoperative management of blunt splenic injury.  相似文献   

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