上下泪小管同时断裂35例手术分析

目的探讨上、下泪小管同时断裂的手术治疗方法。方法上、下泪小管同时断裂共35例,按手术方式分为两组。A组:27例同时行上、下泪小管吻合术;B组:8例仅行下泪小管吻合术。结果A组27例较少发生内眦角变形、睑外翻,上下泪点复位良好。结论为求上、下泪小管断裂术后能达到解剖复位及功能复位,同时行上、下泪小管断裂吻合效果较好。     

Value of spiral CT in hemodynamically stable patients following blunt chest trauma

Introduction: Features of spiral CT (SCT) — fast scanning, dynamic injection of contrast allowing optimal vessel opacification, and supplemental multiplanar imaging — promises to provide increased accuracy in the diagnosis of acute and non acute thoracic vascular disease. Recent work demonstrating the cost effective triage of hemodynamically stable patients after blunt chest trauma for angiography based on dynamic CT findings has prompted an investigation into the accuracy of SCT in this clinical setting. Methods: A retrospective review of all patients seen in the emergency department over the period of one year for aortic, thoracic, or blunt chest trauma evaluation was performed (74 patients) and all SCT scans available were reviewed and data reformatted for optimal delineation of pathology using maximum intensity projection and multiplanar reformation. The accuracy and predictive positive and negative values of SCT were calculated with respect to angiography, surgical, and/or clinical follow up evaluation. Results: Twenty three (31%) patients went directly to angiography owing to mediastinal widening on chest film and hemodynamic instability, of which four were positive and required emergent surgery. Seven hemodynamically stable patients (9%) had noncontrast SCT owing to mediastinal widening on chest film, all of which had angiography with none having great vessel trauma. Fourty four hemodynamically stable patients (60%) had contrast enhanced SCT (ceSCT), of which five (11%) were abnormal and underwent angiography, four of these were positive for aortic damage, one for a subclavian artery laceration. Of the remaining 39 patients who had normal ceSCT; five had angiography, all of which were normal. Of the remaining 34 patients that had normal ceSCT none had adverse outcome on clinical follow-up, minimum of 12 months. Conclusion: The predictive positive value for aortic trauma of ceSCT in blunt trauma is 80%, with a predictive negative value of 100%, indicating that it is feasible for SCT to be a first line exam in blunt chest trauma in the future.     

脑挫裂伤水肿转归时间的探讨

目的总结脑挫裂伤后脑水肿发展与消退的时间,为临床治疗提供依据。方法我院4年来收治的脑挫裂伤的患者174例,至少每3d复查一次CT,根据CT影像表现作为观察脑水肿的指标,记录脑水肿随时间演变的过程。结果所有病例脑水肿在3d内达到高峰,但水肿高峰持续时间存在差异,病程中脑水肿的高峰持续时间3～5d7例,6～8d34例,9～11d112例,12d以上21例。脑水肿高峰持续时间与脑水肿严重程度和挫裂伤的严重程度有显著关系。结论大部分脑挫裂伤脑水肿高峰时间比过去我们认识的要长,故使用控制脑水肿药物的时间应适当延长,特别是严重颅脑损伤患者,并应根据不同情况选择脱水剂。     

Successful treatment of blunt trauma involving complete laceration of the pancreas and duodenum in a 7-year-old child: Report of a case

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patient's postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.     

新型泪道引流管治疗泪小管断裂30例

目的应用新型泪道引流管治疗泪小管断裂,恢复泪道引流通路。方法对30例泪小管断裂患者使用新型泪道引流管作为支撑管行泪小管吻合术,将引流的两端探子分别从上、下泪点插入泪道,通过泪管断端经过鼻泪管至下鼻道开口处,在鼻腔内窥镜直视下,用镊子触及并取出探子于鼻腔外,在探子与硅胶管交界处剪断硅胶管,两端硅胶管在鼻腔内打结留置于鼻腔。术后3月或0.5a拔管。并与以往用硬膜外麻醉管做支架的疗效进行比较。结果30例患者均于植管后3～7d内症状消失,29例拔管后达到治愈标准,无泪管豁开、下睑外翻或泪点外翻等并发症。治疗效果明显优于以硬膜外麻醉管作支架管吻合组。结论新型泪道引流管作为泪小管断裂吻合支撑管,伤口愈合快,成功率高,值得推广使用。     

亚低温冬眠疗法治疗重度脑挫伤的临床研究

目的探讨亚低温冬眠疗法对重度脑挫伤病人的脑保护机理及临床疗效。方法46例重度脑挫伤患者(GCS≤8分)随机分为亚低温冬眠治疗组和常温治疗组。其中亚低温冬眠组22例,入院后4￣12h内行亚低温冬眠治疗,输液泵持续静脉点滴冬眠合剂,将肛温控制在32￣35℃,亚低温冬眠治疗4￣7d,同时检测颈动脉和颈静脉血气、电解质变化、血糖及生命体征等指标。常温组24例除未行亚低温冬眠治疗外,其余综合治疗及监测方法同亚低温冬眠组。两组病人均于伤后3个月根据GOS预后评分判定疗效。结果与常温组比较,亚低温冬眠治疗组脑氧耗明显降低,高血糖情况显著下降,生命体征及电解质等无明显差异,无严重并发症,死残率明显降低,预后显著改善。结论亚低温冬眠疗法具有显著的脑保护作用,临床应用于重度脑挫伤救治安全有效,无严重并发症。     

胸腰椎爆裂型骨折148例

目的探讨胸腰椎爆裂型骨折联合椎板骨折,硬脊膜撕裂与神经损伤特点.方法回顾性分析胸腰椎爆裂型骨折148例;其中并椎板骨折41例,硬脊膜撕裂29例,27例马尾神经嵌夹于椎板骨折间隙;无椎板骨折的107例中,硬脊膜撕裂2例.经统计学处理,两组差别有显著意义(P＜0.01).结果胸腰椎爆裂型骨折,当合并椎板骨折时,易发生硬脊膜撕裂;而硬脊膜撕裂与马尾神经损伤有高度相关性(相关系数r=0.9999,P＜0.01).结论胸腰椎爆裂型骨折联合椎板骨折的特点是存在硬脊膜撕裂的危险,同时有神经组织卡压的可能.后路手术可能是较好的选择.     

原位肝移植供肝撕裂伤的处理

目的 探讨原位肝移植供肝获取过程中发生撕裂伤的处理方式。方法对2018年2月至2021年1月清华大学附属北京清华长庚医院297例原位肝移植手术中供肝撕裂伤的情况进行回顾性分析。对供肝撕裂伤进行分级分度：包膜撕裂＜2 cm为A级,≥2 cm但＜5 cm为B级,≥5 cm为C级;无明显肝实质裂伤即肝实裂深度＜1 mm为I°,≥1 mm但＜5 mm为II°,≥5 mm为III°。根据供肝撕裂伤分级分度情况分析处理方式及手术效果。结果 297例中共发生供肝撕裂伤31例（10.4%）。心脏死亡供者供肝损伤率明显高于脑死亡供者[14.7%（19/129）vs 7.1%（12/168）,P＜0.05]。损伤位于右肝的情况明显多于左肝（26例 vs 5例,P＜0.05）。撕裂伤程度A级15例,B级12例,C级4例;I° 18例,II° 10例,III° 3例。裂伤U型缝合14例,包膜贴敷+U型缝合8例,包膜敷贴可以有效降低C级或III°创伤出血量。结论 基于撕裂伤分级分度选择肝脏U型缝合或包膜贴敷+U型缝合可以有效处理原位肝移植供肝获取中造成的肝脏撕裂伤,降低术中出血风险。     

Primary anastomosis for complete bulbar urethral rupture with rectal laceration caused by straddle injury: A case report

IntroductionThe initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma.Case presentationA 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed.DiscussionThe likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis.ConclusionProper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.