腹腔镜手术与开腹手术治疗腹部创伤的疗效比较

目的 分析、评价腹腔镜手术在治疗腹部创伤中的临床价值.方法 回顾对比分析2010年1月至2012年11月因腹部创伤入院,32例行腹腔镜手术及43例行开腹手术患者的临床资料,比较两组患者的手术时间、术中出血量、术后住院天数和术后并发症发生情况.结果 在术中出血量、术后住院天数和术后并发症发生情况方面,腹腔镜手术组均低于开腹手术组（P＜0.05）.结论 早期腹腔镜探查可明确创伤情况,减轻患者痛苦,避免不必要的开腹手术.在无禁忌证的情况下应推荐患者行腹腔镜手术.     

后腹腔镜下肾囊肿去顶术与开放性手术的对比研究

目的 比较后腹腔镜与开放手术行肾囊肿去顶减压术的临床疗效.方法 回顾性分析65例腹腔镜肾囊肿去顶减压术(后腹腔镜组)与30例开放手术(开放手术组)的临床资料,并比较两组手术时间、术中出血量、术后肠功能恢复情况、术后下床活动时间、住院总天数等指标.结果 后腹腔镜组在术中出血量、术后肠功能恢复情况、术后下床活动时间和住院总天数方面明显优于开放手术组;两组手术时间比较差异无统计学意义(P＞0.05).结论 后腹腔镜肾囊肿去顶术具有创伤小、恢复快、痛苦小的优点,是治疗肾囊肿的首选方法.     

腹腔镜脾切除术16例临床分析

目的探讨腹腔镜脾切除术临床应用价值。方法 35例行脾切除患者分为腹腔镜手术组16例和传统手术组19例,就两组术后并发症、术后一般情况和预后等进行对比分析。结果术中出血量,腹腔手术镜组少于传统手术组（P〈0.05）;术后肠功能恢复时间、下床活动时间和住院时间,腹腔镜手术组短于传统手术组（P〈0.05）。腹腔镜手术组术后发生并发症3例（3/16）,传统组手术为6例（6/19）。结论 腹腔镜下脾切除手术是安全、临床效果良好的微创手术方式,其临床效果优于传统手术方式,值得推广。     

腹腔镜技术在腹部创伤救治中的应用

目的:探讨腹腔镜技术在腹部创伤救治中的疗效和局限性。方法:回顾性分析2013-07-2014-12西南医院急救创伤中心收治的79例因腹部创伤行开腹手术或腹腔镜手术治疗的病例资料。根据手术方式的不同,将患者分为开腹手术组(n=39例)和腹腔镜手术组(n=40例),观察对比2组患者入院时基本信息、手术时间、术中探查结果、ICU住院时间、总住院时间、术后第1天VAS评分以及术后短期并发症等临床指标。结果:腹腔镜手术组平均手术时间长于开腹手术组(P0.05),且术后肠道功能恢复时间、总住院时间均短于开腹手术组(P0.05)。2组患者ICU住院时间及术中探查结果比较差异均无统计学意义(P0.05)。腹腔镜手术组术后并发症1例(盆腔脓肿);开腹手术组术后并发症3例,其中2例为切口感染,1例为急性粘连性肠梗阻。2组患者术后并发症的发生率差异无统计学意义(P0.05)。结论:腹腔镜用于腹部创伤的治疗具有创伤小、恢复快、并发症少、操作安全及有效缩短住院时间等特点。但在腹部创伤的治疗中也应严格掌握适应证,严格遵守探查规范,警惕漏诊可能。在腹腔镜手术遇到困难时,应及时中转开腹手术,以免延误病情,导致严重的并发症的发生。     

腔镜与小切口开放手术行胆囊切除术效果比较

目的比较电视腹腔镜胆囊切除术（LC）及小切口开腹胆囊切除术（MC）2者的临床应用效果。方法回顾分析腹腔镜胆囊切除术82例（A组）及小切口开放性胆切除术36例（B组）的临床资料,就2组手术时间、术中出血量、术后肠功能恢复情况、术后下床活动时间、恢复正常工作时间、术后住院总天数、并发症等指标进行比较。结果A组在手术操作时间、术中出血量、术后肠功能恢复情况、术后下床活动时间、恢复正常工作时间、术后住院总天数、并发症方面明显优于B组,差别有显著性意义（P〈0．05）。结论LC手术患者创伤小、出血少、术后疼痛轻、腹腔干扰少术后粘连轻、恢复快,平均住院时间短,安全可靠等优点,效果优于小切口开放手术,值得临床推广。     

腹腔镜手术治疗腔静脉后输尿管

目的 探讨腹腔镜和传统开放手术治疗腔静脉后输尿管的疗效.方法 回顾分析该院1988年～2010年26例腔静脉后输尿管患者的临床资料.其中15例采用传统开放手术治疗,11例采用腹腔镜手术治疗.比较两种方法在手术时间、出血量、术后肠功能恢复时间、住院时间及并发症情况.结果 腹腔镜手术组手术时间(72.6±21.7)min,出血量(54.1±16.7)mL,胃肠功能恢复时间(2.2±0.5)d,住院天数(7.2±1.9)d,没有出现并发症.开放手术组手术时间(136.8±19.8)min,出血量(245.3±112.2)mL,胃肠功能恢复时间(2.4±0.6)d;住院天数(11.7±4.8)d,3例发生切口感染或脂肪液化.两组手术时间、出血量和住院时间比较,差异具有显著性(P＜0.05).结论 腹腔镜是目前治疗腔静脉后输尿管最佳手术方式.     

异位妊娠不同手术方式治疗与护理效果比较

[目的]比较异位妊娠腹部常规开腹手术及腹腔镜手术治疗、护理效果.[方法]将78例异位妊娠病人随机分为传统开腹手术组和腹腔镜手术组,对两组术前心理紧张及预防用药术中手术时间、手术成功率、术中出血量、住院天数、术后并发症等指标进行比较.[结果]常规开腹手术组病人术前心理紧张、术中出血量、术后并发症发生率、住院天数等与腹腔镜手术组比较,差异有统计学意义.[结论]与传统开腹手术比较,腹腔镜手术具有病人恢复快、创伤小、住院时间短等优点.     

260例腹腔镜手术治疗胆囊结石的临床效果观察

选取行腹腔镜胆囊切除术的胆囊结石患者260例作为腹腔镜组,选取同期行开腹胆囊切除术的胆囊结石患者80例作为开腹手术组,比较两组手术指标及术后并发症发生情况。腹腔镜组中4例中转开腹,腹腔镜组术中出血量明显少于开腹手术组,手术时间、术后饮食恢复时间及住院时间明显短于开腹手术组,术后并发症发生率明显低于开腹手术组(P<0.05)。腹腔镜手术治疗胆囊结石疗效显著,值得临床推广应用。     

腹腔镜保守性手术治疗输卵管妊娠75例分析

目的：探讨腹腔镜保守性手术治疗输卵管妊娠的疗效。方法：将2003年1月～12月住复旦大学附属妇产科医院治疗的95例输卵管妊娠患者，分为腹腔镜保守手术组和剖腹保守手术组，对比观察两组手术效果及手术并发症等。结果：腹腔镜保守手术组血pHCG恢复正常的时间与剖腹保守手术组比较无显著差异（P〉0．05），腹腔镜保守手术组手术时间、术中出血量、肛门排气时间、术后平均住院时间及术后发热、镇痛剂使用例数均明显少于剖腹保守手术组（P〈0．01）。结论：腹腔镜保守手术组优于剖腹组。     

腹腔镜手术治疗卵巢囊肿临床疗效分析

选取我院妇科2012年12月~2015年6月收治的380例卵巢囊肿患者。随机分为对照组和试验组各190例。对照组患者行传统开腹卵巢囊肿剥除术,试验组患者则行腹腔镜卵巢囊肿剥除术。对比两组患者手术操作时间、手术出血量、术后肛门排气时间、术后下床活动时间、术后住院天数及并发症发生情况。结果试验组患者的手术操作时间、手术出血量、术后肠道功能恢复时间、术后下床活动时间、住院天数及并发症发生率均明显著低于对照组(P0.05)。采用腹腔镜手术治疗卵巢囊肿具有微创、术后恢复快等优点,值得进一步推广应用。     

胸腹联合伤48例临床分析

目的探讨胸腹联合伤的特点和诊治方法。方法回顾分析经手术证实的48例胸腹联合伤临床资料。结果开放性损伤21例（占43．8％）,以锐器穿刺伤为主;闭合性损伤27例（占56．2％）,以交通车祸伤为主;受损器官3个以上23例（占47．9％）,术前休克29例（占60．4％）;术前确诊22例（占45．8％）,9例漏诊或延误诊断（占18．8％）;治愈40例,死亡8例（占16．7％）。结论胸腹联合伤伤情复杂、严重,休克发生率及死亡率高;膈肌损伤容易漏诊及延误诊断,重视院内急救、及时纠正休克及尽早手术治疗是抢救成功的关键。     

Penetrating injuries to the colon: analysis by anatomic region of injury

The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%). The average penetrating abdominal trauma index (PATI) was 24 (ascending colon injuries, 23; transverse colon, 26; descending colon, 24; and multiple colon sites, 28). Overall septic morbidity was 15/65 (23%). Colostomy closure was later done in 32/33 (97%), with a morbidity of 7/32 (22%). The mean length of hospital stay for primary repair was ten days and for colostomy (including both required hospital stays), 26 days (P less than .05). These data suggest that primary repair is as safe as colostomy formation for the management of penetrating colon injuries, regardless of anatomic site of injury.     

Retroperitoneal organ injury caused by anterior penetrating abdominal injury in children.

OBJECTIVE: To describe the retroperitoneal organ injury pattern after anterior penetrating abdominal injury in children. SETTING: The paediatric surgical department of a university teaching hospital. PATIENTS AND METHODS: All children presenting with firearm and stab wounds to the anterior abdomen between January 1983 and April 2001. RESULTS: Forty-nine children (34%) with penetrating anterior abdominal wounds had retroperitoneal organ injury. The most injured organs were the descending colon in 17 patients (35%), ascending colon in eight patients (16%), and kidney in seven (14%). The most commonly associated injured organ was the small bowel. Postoperative septic complications were seen in 10 patients (20%). The most common postoperative complication was wound infection. When we compared patients with intraperitoneal organ injury with patients with retroperitoneal injury, there was no difference in parameters such as age, associated organ injury, morbidity and mortality between both groups. The main causative factor of retroperitoneal injuries was shotgun wounds, whereas it was stabbing in intra-abdominal injuries (P<0.05). The number of injured organs and the hospital stay is significantly greater in retroperitoneal organ injuries, and the trauma scores such as the Injury Severity Score (P<0.001) and the Penetrating Abdominal Trauma Index (P<0.001) were found to be significantly higher. CONCLUSION: Retroperitoneal organ injury is commonly associated with anterior penetrating abdominal trauma. Even if there is no preoperative sign of retroperitoneal organ injury, an exploratory laparotomy and a meticulous retroperitoneal exploration should also be performed for associated retroperitoneal organ injury.     

A historical review of penetrating abdominal trauma

The course of history changed because of the deaths of these two men. Although the world doesn't remember Chester Allan Arthur (JAG's Vice President), Theodore Roosevelt became one of our most popular presidents. Neither president's injuries were life-threatening, but they died of postoperative complications. The technology and treatment used for penetrating abdominal trauma have changed tremendously over the past 100 years. Both presidents would survive if they sustained their injuries today.     

创伤性膈肌破裂的早期诊断与治疗(附31例报告)

目的　探讨创伤性膈肌破裂早期诊治的方法。方法　回顾性分析 31例创伤性膈肌破裂患者的临床资料。结果　本组病例致伤原因主要为胸腹部闭合性损伤 (71.3% ) ,31例均手术修补痊愈。早期诊断方法 :X线片平扫描 ,诊断性胸腔穿刺与腹部CT扫描及手术探查。对该病的早期诊断与治疗是决定病情转归的重要因素 ,延迟诊断与早期确诊相比 ,术后并发症增多 ,住院时间长。结论　早期确诊 ,及时手术修复和积极治疗合并伤是救治创伤性膈肌破裂的关键     

胸腹联合伤52例临床分析

目的:总结胸腹联合伤的诊断与治疗特点。方法:回顾1992年至2007年本院及达州市中心医院收治52例胸腹联合伤的临床资料,对其发病原因、部位、合并伤、诊断经过及手术途径等分别进行分析。结果:本组病例车祸伤36例,刀刺伤6例,击打伤4例,坠落伤6例。52例均行手术治疗,其中经左胸切口24例,经右胸切口9例,双侧剖胸4例,剖腹并剖胸术5例,经胸腹联合切口2例,经腹部切口8例。治愈48例,死亡4例,病死率为8%。结论:胸腹联合伤是一种特殊类型的损伤,伤情复杂、严重,死亡率高。临床处理中要注意避免漏诊膈肌损伤。早期及时处理是抢救成功的关键。     

胸腹联合伤的早期诊断和治疗

目的:分析和总结胸腹联合伤早期诊断与治疗的经验。方法:回顾性分析61例胸腹联合伤患者的临床资料。结果:胸腹部开放性损伤26例,胸腹部闭合性损伤35例。术前确诊58例,治愈52例,死亡9例,其中4例死于失血性休克,3例死于创伤后多脏器功能衰竭,2例死于急性呼吸窘迫综合征(ARDS)。结论:胸腹联合伤病情复杂,伤情危重。早期的正确诊断、及时的围手术期处理和并发症防治,是提高治疗效果与降低病死率的关键。     

Management of haemodynamically stable patients with abdominal stab wounds

Objectives: Australasian trauma centres receive relatively low numbers of penetrating injuries from stabbings. There is limited agreement regarding protocols to guide the management of haemodynamically stable patients with penetrating injuries. This has resulted in a wide variation in practice with anecdotally high negative laparotomy rates. The aim of the present study was to review the ED procedures, investigations and disposition of this group of patients. Methods: A retrospective review of all patients presenting with abdominal penetrating injury was undertaken over a 5 year period. Data on demographics, presenting features and management were collected. Results: There were 109 patients who were haemodynamically stable (systolic blood pressure > 90) on arrival to the trauma centre. Diagnostic ED procedures and investigations consisted of wound exploration in 47 (43.1%) patients, focused abdominal sonography in trauma in 44 (40.4%) patients and a CT abdomen in 36 (33.0%) of patients. The sensitivity for focused abdominal sonography in trauma and CT when used together was 77.8%. There were 39 laparotomies performed with a negative laparotomy rate of 23.1%. There were 10 laparoscopies performed, none went on to require a laparotomy. Patients undergoing negative laparotomies spent significantly longer times in hospital than patients managed conservatively or those undergoing laparoscopies. Conclusions: The number of penetrating abdominal injuries remains low. Imaging alone cannot reliably exclude intraperitoneal injury. A greater utilization of ED wound exploration and laparoscopy based on agreed guidelines could improve management. An algorithm for the management of these patients is suggested.     

带蒂大网膜治疗腹腔内脏器损伤的临床体会

目的探讨应用带血管蒂大网膜填塞修补腹腔内脏器损伤的可行性及实用性。方法回顾性分析我院1995~2004年间收治125例经手术治疗因外伤所致的腹腔内脏器损伤的临床资料。结果125例闭合性或开放性腹腔脏器损伤患者均行手术治疗。对肝、脾、胃、十二指肠、右半结肠损伤分别施行了两种不同的修补方式:清除受损伤脏器的失活组织,应用带蒂大网膜填塞、修补术63例,治愈59例(93.6%),死亡4例(6.4%),术后发生各种并发症10例(15.9%);明胶海绵填塞加单纯修补或部分脏器切除术62例,治愈50例(80.6%);死亡12例(19.4%),术后发生各种并发症20例(32.3%)。结论合理选择应用带血管蒂大网膜填塞或修补因外伤所致的腹腔内脏器损伤,有效地提高了伤者术后的治愈率,降低了并发症的发生率和死亡率。