外伤性心脏破裂13例救治体会

目的总结外伤性心脏破裂的急救流程及手术治疗方法。方法回顾性分析广元市第一人民医院2001年6月至2013年6月收治13例心脏破裂患者的临床资料,其中男11例、女2例,年龄20~45(32.0±10.5)岁;病程30 min至2 h,平均(45.0±9.6)min。立即行床旁B超检查,其中12例急诊在全身麻醉、气管内插管下行心脏修补术,同期处理合并脏器损伤。结果 1例术前死于腹腔大出血,1例死于术后弥漫性血管内凝血(DIC),术中发生恶性心律失常2例,术后发生慢性胸骨骨髓炎2例,痊愈出院11例。出院后1个月复查心脏彩色超声,发现4例少量心包积液,余未见异常。结论对于高度怀疑心脏破裂患者,建立快速的救治通道,早期准确诊断、及时手术治疗,是挽救患者生命的关键。     

15例外伤性心脏破裂的救治体会

目的 探讨外伤性心脏破裂的救治方法,以提高抢救成功率.方法 对我院心胸外科于2000年12月～2010年12月收治的15例外伤性心脏破裂进行回顾性分析.多数患者经心脏彩超确诊,15例患者均及时施行开胸手术修补.结果 本组治愈14例,治愈率93％,死亡1例,占7％.本组无严重并发症.结论 快速而准确的诊断是外伤性心脏破裂...     

外伤性膀胱破裂26例诊治体会

膀胱破裂是泌尿系统损伤中的常见病,且多合并其他脏器损伤,易被其他脏器损伤或休克症状所掩盖造成诊治延误,我院成立交通创伤中心后,1997年3月~2005年6月共收治膀胱破裂患者26例,现报告如下:1资料与方法1.1临床资料:本组26例,男17例,女9例,年龄17~51岁,22例为交通创伤,4例为坠落伤。并发阴道裂伤2例,创伤性休克18例,尿道断裂6例,合并脾破裂1例,脑外伤4例,其他部位骨折6例。26例病人均有骨盆骨折。根据临床分类标准[1]:20例为腹膜外型,4例为腹膜内型,2例为混合型。1.2诊断和治疗:诊断结合病史、体征,并采用导尿后膀胱注水试验,结合B超、CT…     

18例外伤性心脏破裂的诊治

心脏外伤约占胸部创伤的7％～12％，其中外伤性心脏破裂有病情危急、病死率高。1993年6月至2004年11月我们共收治外伤性心脏破裂病人18例。现报道如下。     

心脏破裂伤的急救

目的总结心脏破裂伤的急救体会。方法38例心脏破裂伤病人,平均年龄（32．5±10．5）岁。心脏刀刺伤35例,心脏挤压伤2例,鱼叉刺伤1例,均急诊行开胸探查术,修补心脏裂口,同时处理合并损伤。术中回输自体血800～6000 ml。结果术中、术后共死亡3例。1例术后神志障碍,高压氧治疗2周,术后1年恢复正常;1例心脏贯通伤病人,先行ERT修补心脏左、右室裂伤,1个月后行外伤性室间隔缺损介入封堵,顺利出院;3例术后心包积液者经处理后痊愈;其余病人恢复良好,心功能Ⅰ级。结论紧急剖胸解除心脏压塞、修补心脏伤口、控制出血是心脏破裂伤救治成功的关键。     

钝性伤致心脏破裂的救治

心脏外伤病人常因来不及抢救而死亡。闭合性钝性伤致心脏破裂的报道少见。近年来,本院收治心脏闭合钝性伤致心脏结构损伤2例,现就该病的临床特点及急救体会报告如下:1临床资料例1:男性,32岁,因被人用脚踩伤胸部后头晕、头痛、胸闷1天收住入院。查体:血压60/40mmHg,呼吸32次/分,神志清楚,面色苍白,呼吸急促,颈静脉充盈,心前区皮肤局部淤血,两肺无干湿性罗音,心率120次/分,律齐,胸骨左缘3、4肋间IV级收缩期杂音,传导范围较广,触及收缩期震颤。心肌酶学:CK1537U/L,CK-MB153U/L血电解质正常范围,血肌酐221mol/L尿素氮21.6mmol/L。心电图:…     

救治心脏刀穿透伤的体会

５例心脏穿透伤病人，３例急症剖胸行心脏修补术获救，２例由于失去手术机会死亡获救３例的为刀刺伤，２例为右室前壁，１例工室前壁。心脏伤口分别为２ｃｍ、０．８ｃｍ、２ｃｍ大小。均穿透心肌全层达心这内。死亡的１例是经左胸枪弹穿透左右心室，１例为由左胸刀穿透右讣和主动脉。     

26例骨盆骨折救治体会

自2000年1月至2001年12月我们急诊救治骨盆骨折26例，现就治疗中的经验教训总结如下。     

心脏破裂成功救治一例

患者,男,28岁,约70kg,因"车祸致胸腹部闭合性外伤18h"入院。患者18h前发生车祸,出现胸痛、胸闷,无头痛,无腹胀腹痛,无大小便失禁,为进一步治疗入院。入院后予以抗炎、补液、右侧胸腔闭式引流等治疗,因血压下降,腹穿     

Isolated Traumatic Gallbladder Rupture

Blunt traumatic injury to the extrahepatic biliary system is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. Isolated gallbladder rupture secondary to blunt abdominal trauma is even more uncommon, but poses a potential life-threatening surgical emergency. Delay in the diagnosis of the injury for several days due to no or vague symptoms and an insidious course are common. Early diagnosis is essential, as protracted treatment may result in significant morbidity and mortality. We report the case of a patient who suffered an isolated gallbladder rupture due to blunt abdominal trauma from a fall. The subject of isolated traumatic gallbladder rupture is reviewed because of the rarity of this condition and the diagnostic challenges it poses.     

选择性出血动脉栓塞治疗创伤性肝脏破裂出血

目的 探讨选择性出血动脉栓塞在处理创伤性肝脏破裂出血中的止血效果.方法 回顾性分析2004年1月至2011年6月期间笔者所在医院收治的63例创伤性肝脏破裂出血患者的临床资料,均首先采用股动脉穿刺插管,肝动脉造影显示出血部位,然后将微导管放至出血分支动脉,注入栓塞剂,选择性栓塞止血.结果 63例均顺利完成肝动脉造影,显示肝左动脉分支出血8例,肝右动脉分支出血39例,肝左、右动脉分支均有出血10例,6例未见明确出血.57例出血患者均完成栓塞并成功止血,其中1处栓塞36例,2处栓塞11例,3处及以上栓塞10例.6例无明确出血表现者未做栓塞.无继发出血病例,无死亡病例.栓塞后1周血红蛋白及红细胞比容基本恢复正常.63例随访0.5～1年,无肝脏再出血,肝功能正常.结论 选择性出血动脉栓塞是治疗创伤性肝脏破裂出血的一种安全、有效以及微创的手段.     

选择性出血动脉栓塞在外伤性脾脏破裂出血处理中的应用

目的探讨选择性出血动脉栓塞在处理外伤性脾脏破裂出血中的效果。方法采用Seldinger技术穿刺右侧股动脉,把导管放至脾动脉后造影,显示脾脏出血部位,然后把微导管放至出血（叶、段）血管,注入PVA、明胶海绵颗粒等栓塞剂进行止血。结果44例脾动脉造影显示脾外伤（夏氏分级）Ⅱ级23例,Ⅲ级19例,Ⅳ级2例。44例均顺利完成选择性出血血管栓塞,其中脾叶动脉血管栓塞13例,脾段动脉血管栓塞31例;1次栓塞成功35例,再次栓塞成功9例。无继发出血及开腹手术病例,无死亡病例。术后1周血红蛋白、红细胞压积恢复正常。44例随访0.5～1年,无再出血、严重感染及其他并发症发生。结论选择性脾动脉出血血管栓塞是治疗外伤性脾破裂出血的一种有效、简便、微创的方法。     

Management of Traumatic Diaphragmatic Rupture

Purpose Diaphragmatic rupture following trauma is often an associated and missed injury. This report documents our experience of treating traumatic diaphragmatic rupture (TDR).Methods We retrospectively analyzed 18 patients who presented between 1993 and 2000 with TDR, caused by blunt injuries in 14 and by penetrating injuries in 4.Results The average age of the patients was 32 years and the female to male ratio was 4:14. The TDR was right-sided in 5 patients and left-sided in 13. The diagnosis was made by chest X-ray, thorax and upper abdominal computed tomography, and upper gastrointestinal contrast studies. The most common herniated organs were the omentum (n = 11), stomach (n = 10), spleen and colon (n = 9), and liver (n = 2). Sixteen diaphragmatic injuries were repaired primarily, and two were repaired using a prolene mesh graft. The mortality rate was 5.5% (n = 1).Conclusions A high index of suspicion and early surgical treatment determine the successful management of TDR, with or without the herniation of abdominal organs. The surgical approach to TDR is individualized. Acute left-sided injuries are best approached through the abdomen, although we prefer the chest approach, adding laparotomy when necessary. Acute right-sided injuries and chronic injuries should be approached through the chest.Nispetiye cad. Profesorler Sitesi C3 Blok, A-kapisi No: 66/8, Etiler 34337, Istanbul, TurkeyPresented in part at the 8th European Conference on General Thoracic Surgery, London, UK, November 1–3, 2000     

Treatment of Hallux Varus After Traumatic Adductor Hallucis Tendon Rupture

Hallux varus is a deformity of acquired and less commonly congenital etiologies. It can present secondary to the release of the soft tissues surrounding the first metatarsophalangeal joint surfaces during bunion surgery. If the condition is left untreated, it can be debilitating, with progressive pain and destruction of joint surfaces. Many procedures have been described for the treatment of iatrogenic causes of hallux varus; however, little has been reported regarding the success of procedures when used for less typical traumatic causes. In the present report, a case is presented of surgical repair of a traumatic hallux varus using a suture and button fixation device and 3-year patient follow-up data.     

急诊腹腔镜脾切除术在外伤性脾破裂中的应用

目的探讨急诊腹腔镜脾切除术（1aparoscopic splenectomy,LS）治疗外伤性脾破裂的可行性。方法回顾分析我院2010年11月-2012年3月因外伤性脾破裂行急诊Ls20例的临床资料,根据脾蒂的不同类型,18例用Endo．GIA施行一级脾蒂离断,2例用Hem-o-lok施行二级脾蒂离断。结果20例手术均成功,无中转开腹,手术时间80-180min,平均110min,术中腹腔内有出血约700-1,2500ml,平均1300ml。术后无明显并发症发生。20例术后随访6个月,所有患者10天基本恢复正常生活,15—45天恢复正常工作,无严重术后并发症。结论急诊Ls治疗外伤性脾破裂可行。     

Blunt Traumatic Rupture of the Left Atrial Appendage

Background: The diagnostic evaluation and surgical management of blunt cardiac rupture is one of the challenges of trauma surgery. Case Study: We report the case of an 18-year-old male with blunt traumatic left atrial apendage rupture who was brought to the hospital after a fall from the sixth floor of a building. On arrival at the emergency department, he developed signs of cardiac congestion. Ultrasonography of the heart through the subxiphoid window, as part of the focused assessment for the sonographic examination of the trauma patient (FAST), revealed cardiac tamponade. The injury was successfully repaired after median sternotomy. Discussion: Clinical symptoms, diagnostic considerations, and treatment modalities are commented on. The focus is on the role of FAST as a diagnostic tool in this case. Received: December 12, 2001; accepted: February 25, 2002 An erratum to this article is available at .     

Blunt Traumatic Rupture of the Left Atrial Appendage

Background: The diagnostic evaluation and surgical management of blunt cardiac rupture is one of the challenges of trauma surgery. Case Study: We report the case of an 18-year-old male with blunt traumatic left atrial apendage rupture who was brought to the hospital after a fall from the sixth floor of a building. On arrival at the emergency department, he developed signs of cardiac congestion. Ultrasonography of the heart through the subxiphoid window, as part of the focused assessment for the sonographic examination of the trauma patient (FAST), revealed cardiac tamponade. The injury was successfully repaired after median sternotomy. Discussion: Clinical symptoms, diagnostic considerations, and treatment modalities are commented on. The focus is on the role of FAST as a diagnostic tool in this case. Received: December 12, 2001; accepted: February 25, 2002 An erratum to this article is available at .     

自发性食管破裂34例的临床诊治分析

目的探讨自发性食管破裂的临床特征、诊断和治疗方法,以提高临床诊治水平。方法回顾性分析自1996年1月至2010年6月苏北人民医院收治34例自发性食管破裂患者的相关临床资料,其中男28例,女6例;平均年龄57.6(32～80)岁。主要临床症状为呕吐后出现胸腹剧烈疼痛、发热、呼吸困难和休克等,从发病到确诊时间4 h～7 d。保守治疗13例,均采用胸腔闭式引流,并行逆行胃肠减压和空肠造瘘营养支持;食管修补术治疗21例,手术为食管裂口分层吻合,同时行空肠造瘘及逆行胃肠减压。结果全组无死亡,均治愈出院。经保守治疗的13例患者平均住院时间为46 d,行食管修补术的21例患者平均住院时间为17 d,术后破裂口均一期愈合。34例患者随访l～8年,失访4例;经保守治疗的患者中随访11例,手术治疗的患者中随访19例,随访期间均能正常饮食,无食管狭窄、反流性食管炎及慢性脓胸等症状。结论自发性食管破裂是一种误诊率和病死率均较高的胸外科急症,早期诊断和尽早手术闭合破裂口和通畅引流是治疗的关键。