创伤性膈疝25例临床诊治体会

目的总结创伤性膈疝的临床诊断和早期治疗的经验,为减少误诊、漏诊及提高治愈率提供参考。方法对25例创伤性膈疝患者的临床资料与治疗经验进行总结分析,21例于伤后24 h内就诊,3例于伤后48h就诊;1例CT检查发现空腔脏器疝入胸腔,追问病史,2年前有外伤史。术前均完善胸片、胸腹部CT和胸腹部B超检查,术前均获确诊,确诊率100%。采用经胸手术14例,经腹手术8例,胸腹联合切口3例。疝内容物为肝3例,脾6例,胃7例,大网膜4例,结肠2例,其他3例。同时行肝修补术3例,行脾切除术6例,行胃肠破裂修补术13例。结果术中发现左侧膈疝23例,右侧膈疝2例。膈肌呈线性破裂20例,呈不规则破裂5例。膈肌破裂长度平均为7.6(4～16)cm。治愈23例,死亡2例,病死率8%。23例均获随访,平均随访时间28.5(6～40)个月,未见膈疝复发。结论创伤性膈疝多发生于严重胸腹部损伤,缺乏特异性临床表现,一经确诊应尽早手术治疗。修补膈肌裂口,及时正确地处理合并脏器伤是提高治愈率,降低死亡率的关键。     

胸腹联合伤32例诊治分析

胸腹联合伤常合并多系统多脏器损伤,伤情复杂,诊断多较困难。我院1967年6月至1969年6月及1975年8月至1990年12月收治胸腹联合伤32例。本文就其诊断和治疗的体会报告如下。临床资料一般资料:本组男性30例,女性2例。年龄4～6O岁,平均26岁。急诊入院29例,余3例在外院漏诊分别于伤后2年5个月及3年和32年入院。     

急诊切痂防治磷烧伤后磷中毒16例

临床资料:本组磷烧伤患者16例,其中男13例、女3例,年龄6-36岁。烧伤总面积(34±29)％,其中Ⅲ度(24±23)％TBSA。伤后1 h入院8例,1 h后至6 h入院6例,6 h后至48 h入院2例。烧伤总面积>50％TBSA者5例,合并休克5例、吸入性损伤5例。     

腹部闭合性损伤90例诊治体会

现就我院急救中心 2002至2008年收治的90例腹部闭合性损伤患者的诊断与治疗情况报告如下. 临床资料 1.一般资料:本组男71例,女19例;年龄4～81岁,平均40岁.车祸伤35例(38.9%),钝器伤28例(31%),高处坠落伤18例(20%),挤压伤9例(10%).来院时休克21例(23.3%),意识障碍7例(7.8%),剧烈腹痛38例(42.2%),呼吸困难22例(24.4%),血尿11例(12.2%).单纯腹部损伤13例,胸腹联合伤17例,合并四肢骨折或脱位28例,合并有颅脑损伤12例,脊柱损伤5例,颜面部损伤15例.     

DCS在胸腹联合伤诊治中的应用及对血清炎症因子水平的影响

探讨损伤控制外科手术策略在胸腹部联合创伤患者中的救治效果及对患者血清炎症因子水平的影响。选取137例以腹部创伤为主的胸腹部联合创伤患者,其中60例作为A组(损伤控制外科手术策略救治),77例作为B组(传统的手术策略进行救治),对比两组患者的血清炎症细胞因子变化、临床疗效。入院24 h、48 h、72 h,A组患者的血清内毒素、IL-6、IL-8、IL-1β、TNF-α水平显著低于B组患者(P0.05);入院时,A组的乳酸清除时间、体温恢复时间、PT、APPT的恢复时间显著低于B组患者(P0.05);A组患者的ICU住院时间、总住院时间显著低于B组患者(P0.05)。损伤控制外科手术策略在胸腹部联合创伤患者中的应用有利于减轻患者的炎症反应程度,对于患者早期生命体征恢复具有一定的临床价值。     

胸腹联合伤的AIS-ISS评分及外科治疗

目的总结胸腹联合伤创伤评分与临床诊断和治疗方法的关系，旨在提高该病的诊断及治疗水平。方法回顾分析83例胸腹联合伤患者临床资料，并对其进行简明创伤分级（AIS）及损伤严重程度评分（ISS）。其中交通事故伤38例，刀刺伤24例，坠落伤8例，挤压伤8例，重物砸伤5例。患者手术治疗43例，胸腔闭式引流28例，保守治疗12例。结果治愈73例，死亡10例，死亡率12．1％。结论详细询问病史及查体，胸、腹部X平片，CT、胸腹部B超、消化道钡剂造影及钡灌肠造影检查有助胸腹联合伤的诊断。对诊断明确的胸腹合并伤，首先改善呼吸功能，恢复有效循环量，对ISS评分大于26的患者，应积极做好手术准备。     

老年人急性胆囊炎急诊腹腔镜胆囊切除术时机的探讨

目的探讨老年人急性胆囊炎急诊腹腔镜胆囊切除术(LC)的可行性及时机。方法回顾分析86例65岁以上老年人急性胆囊炎急诊LC的临床资料。结果成功完成LC83例,中转开腹3例,中转率3.5%;无肝外胆管损伤等严重手术并发症发生。发病48h内行LC42例,全部完成LC,无手术并发症;发病48～72h行LC24例,中转开腹1例,术后并发毛细胆管漏1例,胸腹部皮下气肿1例;发病72h以上行LC20例,中转开腹2例,术后并发毛细胆管漏2例,一过性黄疸2例,全身皮下气肿2例,并发症发生率为30.0%。全组病人均痊愈出院。结论老年人急性胆囊炎经合理围手术期处理可安全完成LC,发病48h内行LC成功率高。     

58例腹部闭合伤诊治体会

自1989年7月～1996年12月,共收治腹部闭合伤58例,现报告如下。本组男49例,女9例;年龄5～68岁。损伤脏器:脾破裂28例,肝破裂6例,十二指肠损伤1例,空肠破裂8例,结肠破裂3例,膀胱损伤4例,后腹膜血肿4例,肾损伤4例。有合并伤22例(3.8%),肋骨骨折8例,脑外伤6例(合并脊柱损伤1例),骨盆骨折3例,四肢骨骨折3例,胸腹联合伤2例。本组行剖腹探查51例,其中治愈48例(94%),死亡3例(5.9%)。非手术治疗7例,治愈3例,死亡4例。讨论:一、早期诊断:(1)详细了解受伤史,并与一些必要的抢救措施如止血、输液、抗休克等同时进行。(2)全面而有重点的体格检查:如腹痛与…     

17例热水泥重度吸入性损伤的治疗

我院近12年收治热水泥吸入性损伤48例,其中重度17例。通过早期诊断和灌洗,早期通气支持和早期激素治疗,治愈13例,死亡3例,放弃治疗1例,疗效满意。临床资料　本组17例,男15例,女2例。年龄24～52岁,平均(34±8.2)岁。均合并有体表烧伤,面积13%～50%,平均(24±11.5)%ＴＢＳＡ。均为密闭或半密闭状态水泥喷窑致伤,有不同程度呼吸困难,伤后入院时间40ｍｉｎ～6ｈ,平均(3.8±1.5)ｈ。诊断依据:(1)密闭或半密闭状态的水泥喷窑致伤。(2)6ｈ内呼吸困难进行性加重,气管切开后不能缓解。(3)纤维支气管镜检查下呼吸道(声门以下)见大量水泥沉积。后两者最…     

地震灾害致腹部创伤的诊治体会

目的研究特大地震灾害所导致的腹部外伤的分类和预后,总结其救治经验。方法2008年5月12日至22日江油市903医院收治589例地震伤者中24例（4．1％）合并腹部伤,对其伤情资料进行统计分析。结果24例腹部伤中,3例由于严重的胸腹伤在运送至医院途中或到院即死亡,21例收治住院,5例由于严重胸、腹部伤或颅脑损伤在入院后12h内死亡,总病死率33．3％。常见的腹部伤是腹壁挫伤、腹膜后血肿、脾破裂、肝挫裂伤。所有伤者均合并软组织损伤,23例（95．8％）合并其他重要脏器损伤。存活伤者16例,经及时积极救治,预后良好。结论早期甄别伤情、明确诊断,积极抗休克,选择恰当的治疗方式,及时处理合并伤可以有效降低病死率。     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.