影像学检查在腹部闭合性损伤中的应用及评价

腹部影像学检查在腹部闭合性损伤的诊断中具有重要作用。本文结合我们的体会 ,介绍如下。一、B超1.能快速准确地判断腹腔内出血 :B超对腹部闭合性损伤所致的腹腔积液的诊断敏感性为 10 0 %。典型腹部闭合性内脏损伤 ,诊断性腹腔穿刺 (diagnosticperitoneallavage ,DPL)阳性者 ,诊断多不困难。但是对于受伤时间较短 ,出血量少 ,特别是腹腔积血被包裹或体型较胖者 ,少量积液 (血 )于肠袢间或腹内间隙者 ,DPL阳性率较低。适时B超检查和B超定位穿刺可提高DPL的阳性率 ,降低假阴性率。2 .可行床旁检查 :由于腹部闭合性损伤常伴严重休克等各…     

腹腔积液对空腔脏器损伤的诊断意义的评价

关于空腔脏器损伤的诊断依据,一直以来强调的是腹膜刺激症、腹腔游离气体、腹穿有阳性发现等.但临床上确实会遇见少数空腔脏器损伤的病人并不具备上述依据,而往往能通过影像学检查发现不等量的腹腔积液.此研究回顾本院近4年来所有的腹部闭合伤患者的资料,评价对无实质性脏器损伤的腹部闭合伤患者所伴有的腹腔积液对空腔脏器损伤的诊断意义.     

B型超声对急性闭合性腹外伤的诊断价值

目的:急性闭合性腹外伤在外科疾病中较为常见。本院超声诊断急性闭合性腹外伤53例中,与手术后或临床诊断基本相符者41例,符合率为77.4％,特别是对腹腔实质性脏器损伤的诊断,其特异性高、准确性高。就是对空腔脏器损伤的诊断也可提供50％以上的信息。从而为外科临床医生提供及时、准确的参考信息。B超以其迅速、及时、方便、准确、可靠且无痛苦、无创伤等优点已成为对急性闭合性腹外伤诊断的首选检查之一。     

CT对急诊腹部闭合性损伤的诊断价值

目的：分析CT对急诊腹部闭合性损伤的诊断价值。方法回顾性分析63例本院接诊的急诊腹部闭合性损伤患者的CT资料,对比手术所见,评价CT对急诊腹部闭合性损伤的诊断符合率。结果63例腹部闭合性损伤中共发现腹腔内实质性脏器和空腔脏器损伤77处,损伤脏器主要包括脾脏、肝脏、肾脏、胰腺、胃、空肠等,并且在CT平扫时可清晰显示腰椎部骨折及腹水情况,其中有1例漏诊,漏诊率为1.59%。结论 CT不仅能清楚显示闭合性的盆、腹腔脏器的损伤,还能对损伤进行初步的分级,对急诊腹部闭合性损伤有很重要的诊断价值,可快速精准的对患者进行诊断。     

闭合性腹部损伤行B超诊断的临床意义探讨

目的：研究探讨B超检查对闭合性腹部损伤中的诊断临床意义。方法回顾性分析2013年1月至2013年12月本院收治的闭合性腹部损伤患者128例,入院就诊后行B超检查,并行手术治疗,根据手术结果对照分析B超检查闭合性腹部损伤准确率。结果经过B超检查和手术结果对比观察所示,128例闭合性腹部损伤患者中经手术证明腹部实质性脏器损伤患者93例（占72.66％）,B超诊断准确率为91.40％,经手术证明腹部非实质性脏器损伤患者35例（占27.34%）,B超诊断准确率为74.29％,B超检查腹部闭合性实质器官损伤准确率优于非实质性器官准确率。结论 B超检查诊断闭合性腹部损伤有较高的准确率,可为临床进一步准确治疗提供重要的依据,因此是闭合性腹部损伤诊断的首选方法,适合临床广泛应用。     

腹部闭合性损伤的超声诊断价值

B超是以二维图像显示腹腔脏器的形态、大小、内部回声,并能实时显示脏器组织上下、前后与左右间的毗邻关系,故在腹部闭合性损伤的诊断中有着其它检查不能替代的特殊作用。鉴于超声对水的穿透力极强,所以不管是腹腔实质脏器或大血管损伤引起的大出血,还是空腔脏器破裂导致的腹腔     

浅析B超在腹部闭合性损伤中的价值分析

目的:分析B超检测技术在腹部闭合性损伤当中的分析价值。方法:将我院2004年5月～2005年5月间住院治疗,且通过手术证实为腹部闭合性损伤患者的120例,对患者的B超检查进行分析,探讨B超在腹部闭合性损伤当中的应用价值。结果:全部的患者当中,采用B超进行检查与诊断的结果,和手术的结果相符的人数较大、诊断相符率也较大。结论:在对腹腔闭合性损伤的诊断过程中,采用B超进行检查,具有良好的诊断价值[1]。     

急诊床边超声对腹部闭合伤肝脾胰损伤临床诊断与治疗中的价值

目的探讨急诊床边超声检查对腹部闭合伤致肝脾胰损伤的诊断的应用价值。方法应用B超对急诊腹部外伤行床边超声检查,观察肝脾胰等腹部脏器声像图有无异常改变,重点观察腹腔内有无液体。结果全组221例,有肝、脾、胰损伤的腹部外伤共164例,超声对肝脾胰实质性脏器损伤诊断总符合率92.07%,单纯肝、脾、胰损伤诊断符合率为96.77%,肝脾或脾胰联合损伤诊断符合率为80.95%,合并有其它脏器损伤的肝脾胰损伤诊断符合率为73.68%。漏诊11例,误诊2例,漏、误诊率7.92%。所有164例经手术治疗（122例）或CT、MRI检查保守治疗（42例）证实。结论急诊床边行超声检查对腹部闭合性外伤致肝脾胰损伤的诊断符合率高,是临床诊断的重要手段,能为临床提供快速、可靠诊断依据。     

CT检查在腹腔实质器官损伤中的临床价值

目的 探讨腹腔实质器官损伤中CT影像学表现的临床价值.方法 对外伤所致腹部脏器损伤的159例患者行平扫和(或)增强扫描,增强扫描采用动脉期、实质期,肾脏加做延迟期,与行增强扫描复查病例进行对比分析.结果 159例病例中,98例CT诊断为腹腔实质脏器挫裂伤,经手术与临床追踪得到证实,22例为单纯空腔脏器损伤或脊柱、骨盆骨折,39例为阴性,检查阳性率为75.5%(120/159),诊断符合率为98.1%(156/159).结论 CT检查能清楚显示实质脏器内损伤情况、包膜下血肿、腹膜后血肿、腹腔积液量,能对损伤的程度进行分级,正确选择扫描技术在腹部损伤诊断中有重要的临床价值.     

CT在闭合性腹部外伤中的应用及诊断价值

目的探讨CT在闭合性腹部外伤中的应用及诊断价值。方法对68例闭合性腹部外伤患者的临床资料进行回顾性分析。结果 68例中35例合并有不同程度的腹腔积液。外伤经CT检查胰腺均未发现异常,10 d后CT复查出现1例胰腺囊肿。68例中肿瘤破裂4例,复合伤9例,肾脏损伤6例,肝脏损伤17例,脾脏损伤28例,肠管破裂与外伤性膈疝各2例。3例患者初次CT检查正常,1周后CT复查却发现肾包膜下有血肿。结论对于闭合性腹部外伤,CT检查可清楚地显示其相邻脏器结构及肝脏、肾脏、脾脏及胰脏等脏器受损情况,其诊断结果为临床下一步制定治疗方案具有重要意义。     

汶川地震德阳市腹部损伤的调查与分析

A magnitude of 8.0 earthquake struck on Wenchuan on May 12, 2008. Until July 1, 1393 injured persons had been admitted to Deyang People's Hospital. Of all injured persons, 32 were diagnosed with abdominal injury, including 18 men and 14 women. All the abdominal injuries were closed injury, and multiple abdominal viscera were involved in the abdominal injuries after the earthquake. Careful examination is crucial in preventing missed diagnosis. The incidences of the liver and spleen injuries were significantly higher than that of the intestine, and the reason may be that the liver and spleen are the parenchymal viscera. Diagnostic abdominocentesis can timely diagnose the parenchymal viscera with severe blood loss. Diagnostic peritoneal lavage combined with selective CT scan can timely diagnose the abdominal injuries with comparatively low cost.     

Jejunal transection following trivial trauma: Case report and review of literature

IntroductionSevere hollow organ injury following trivial blunt abdominal trauma is uncommon. If it occurs it can easily be missed during routine clinical evaluation. Though less than ten cases of jejunal transection following trivial trauma have been reported in literature, this is the first case of jejunal transection occurring in a patient who fell while walking.Case presentationWe report a 32 year old female Ugandan, who walked into the emergency room due to abdominal pain following a fall while walking. She was found to be hemodynamically stable and was initially hesitant to do further investigations but finally accepted to go for abdominal ultrasound scan and a chest x-ray. Abdominal ultrasound scan noted free peritoneal fluid and erect chest radiograph revealed a pneumoperitoneum. She was admitted for an exploratory laparotomy. At laparotomy we found a complete jejunal transection with mesenteric laceration. Primary anastomosis was done; the patient had an uneventful recovery and was discharged on the tenth postoperative day.DiscussionAny trauma to the abdomen can potentially cause devastating injury to hollow viscera and should therefore be evaluated thoroughly.ConclusionThis case demonstrates that even in a resource limited setting, basic investigations like an abdominal ultrasound scan and erect chest radiographs are important when managing a patient with blunt abdominal trauma even though the injury seems trivial.     

Peritoneal lavage in closed abdominal injury

Peritoneal lavage is a sensitive method of detecting intra-abdominal injuries following closed abdominal injury. Our indications for peritoneal lavage are: severe head injury, severe thoracic injury, unexplained hypotension in a patient with possible blunt abdominal injury and patients on artificial ventilation. We present 40 patients with multiple injuries who underwent peritoneal lavage for suspected closed abdominal injury. Twenty-two lavages were positive and 19 laparotomies were performed, of which 18 revealed intra-abdominal injuries. Eighteen lavages were negative; no laparotomy was performed in this group. There was one false positive, but no false negative lavage.     

The problem of the closed abdominal injury in polytrauma patients]

The histories of 66 patients with blunt abdominal trauma requiring surgery in the period from 1985 to 1989 were analysed. The patients were divided into three groups on the basis of the other injuries present. Group I, isolated blunt abdominal trauma and blunt abdominal trauma with slight concomitant injuries (18 patients, ISS 17.17 +/- 1.40); group II, blunt abdominal trauma with severe concomitant injuries but without craniocerebral trauma (23 patients, ISS 29.34 +/- 1.45); and group III, blunt abdominal trauma with severe concomitant injuries and an additional craniocerebral trauma (25 patients, ISS 31.08 +/- 1.27, GCS: 10.04 +/- 0.88). Initially, the diagnosis was made in 23 cases by means of diagnostic peritoneal lavage and in 43 cases by means of sonography. The subsequent laparotomy revealed the ultrasound findings to have been false-positive in 3 cases. No false-negative ultrasound findings were demonstrated at all. Peritoneal lavage, on the other hand, was found to have yielded false-negative and false-positive findings in 2 cases each. Counting from the time of admission, the time up to diagnosis of the intra-abdominal injury was 85 +/- 14.3 min in group I, 82 +/- 9.9 min in group II, and 86 +/- 12.9 min in group III. Thus, the presence of severe additional injuries did not lead to any significant delay in the diagnosis of blunt abdominal injury requiring surgery. The total mortality rate was 18.18% (group I, 11.1%; group II, 21.7%; group III, 20.0%). Six patients died in the acute phase and a further six patients during their stay on the intensive care ward.     

The role of computed tomography in blunt abdominal trauma in children

This study was performed in order to test the hypothesis that abdominal computed tomography (CT) can assist in the decision to perform laparotomy in children following blunt trauma to the abdomen. Three hundred forty children with blunt abdominal trauma underwent evaluation with CT. Abdominal injuries were detected in 84 children (25%). These included: 75 injuries to solid viscera in 60 patients (30 splenic, 29 hepatic, 13 renal, and three pancreatic); four injuries to hollow viscera (three small bowel transections, and one rupture of the urinary bladder); and 23 skeletal injuries (21 fractures of the pelvis, and two lumbar spine subluxations). Injury to solid viscera was categorized as minor in 32 (43%), moderate in 18 (24%), or severe in 25 (33%) according to an assessment of the percentage of parenchyma involved. Hemoperitoneum was detected in 42 patients, and characterized as small in 18 (43%), moderate in nine (21%), and large in 15 (36%). CT was useful in establishing the location and extent of injuries, and in detecting the presence of blood or air in the peritoneal cavity. However, the extent of injury to solid viscera detected on CT did not correlate with the need for laparotomy. Of 46 moderate to severe anatomic injuries of the liver, spleen or kidney, only five (9%) required surgical intervention because of persistent bleeding or infection. Although laparotomy occurred more frequently in the presence of a large hemoperitoneum, only 6/24 (25%) with moderate to large hemoperitoneum required surgical exploration. This analysis confirms the usefulness of CT for detection of location and extent of injury in pediatric blunt abdominal trauma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Initial evaluation of the patient with blunt abdominal trauma

Unrecognized abdominal injury remains a distressingly frequent cause of preventable death following blunt trauma. Peritoneal signs are often subtle, overshadowed by pain from associated injury, and masked by head trauma or intoxicants. The initial management of the patient with blunt abdominal trauma should parallel the primary survey of airway, breathing, and circulation. Diagnostic peritoneal lavage remains the cornerstone of triage in patients with life-threatening blunt abdominal trauma. The only absolute contraindication to the procedure is an existing indication for laparotomy. Computed tomography is useful as a complementary diagnostic tool in selected patients, and it is the critical test for guiding nonoperative management of known intraperitoneal trauma. Routine ancillary tests for potentially occult injuries include nasogastric-tube placement for ruptures of the left diaphragm, Gastrografin contrast study for duodenum perforation, and pyelography for urologic injury. Ultrasonography may become a valuable tool in the initial assessment of the injured abdomen. Ultimately, the most important principle in the management of blunt abdominal trauma is repeat physical examination by an experienced surgeon.     

The accuracy of diagnostic laparoscopy in trauma patients: a prospective, controlled study

BACKGROUND: Numerous studies advocate the use of diagnostic laparoscopy (DL) for abdominal trauma, but none have documented its ability to diagnose specific injuries. This study tests the hypothesis that DL can accurately identify all significant intra-abdominal injuries in trauma patients. METHODS: Of trauma patients requiring laparotomy for presumed injuries, 47 underwent DL followed by laparotomy. Injuries noted at laparoscopy were compared with those found at laparotomy. RESULTS: Of these, 14 patients had no significant injuries necessitating operative intervention noted at laparoscopy and celiotomy. The remaining 33 patients harbored 93 significant injuries at laparotomy, of which only 57.0% were found by DL. DL possessed poor sensitivity (<50%) for injuries to hollow viscera. Despite DL's poor performance in finding specific injuries, it possessed excellent sensitivity (96.2%), and specificity (100%) for determining the need for therapeutic celiotomy. CONCLUSIONS: DL offers no clear advantage over diagnostic peritoneal lavage and computed tomography in blunt trauma. Its utility lies in assessment of the need for laparotomy in patients with penetrating wounds. Currently, DL cannot consistently identify all abdominal injuries, disqualifying it as a therapeutic tool in abdominal trauma.     

A model of port-site metastases of gallbladder cancer: the influence of peritoneal injury and its repair on abdominal wall metastases.

BACKGROUND: Recent surgical literature contains several reports of wound metastases of unexpected gallbladder cancer after laparoscopic cholecystectomy. We hypothesized that peritoneal injury caused by trocar insertion potentiates wound metastases. This study was designed to determine the effect of peritoneal injury on tumor implantation. METHODS: Cultured human gallbladder cancer cells were injected into the peritoneal cavity of mice immediately after surgical procedures. In a peritoneal injury group muscle and the peritoneum were perforated; in a peritoneal injury and repair group each muscle and peritoneal wound was sutured carefully; in a laparoscopic model group animals underwent peritoneal insufflation with carbon dioxide gas and tumor cell injection and then the abdominal wall was perforated. Some mice (controls) were not subjected to any surgical procedure. All mice (n = 178) were killed 2 weeks after tumor cell injection and were examined for tumor implantation. RESULTS: Although no control mice showed intraperitoneal tumor, all mice in the peritoneal injury group showed tumors at the injured sites. In the laparoscopic model group, 90% of injured sites had tumors. The traumatized site-specific implantation rate in the peritoneal injury and repair group was only 40%, whereas it was 100% in the peritoneal injury group (P < .001). CONCLUSIONS: Peritoneal injury enhances peritoneal implantation of carcinoma cells. Repair of injured peritoneum at trocar sites may reduce the frequency of wound metastases in laparoscopic surgery for unexpected gallbladder carcinoma.     

Differential diagnosis and treatment of acute abdominal injuries: Method employed at the University of Minnesota Hospitals

In all acute abdominal injuries, two factors influence the surgeon in his choice of a surgical or conservative way of treatment: (1) Whether the trauma was blunt or penetrating and (2) whether a solid or hollow organ was injured. It may be said that nearly all penetrating wounds and certainly all perforations of hollow viscera should be operated upon as soon as the condition of the patient permits. The question, however, is: Given a history of either blunt or penetrating trauma to the abdomen, how can one be sure as whether a hollow or solid organ has been injured? The history, location of the trauma and clinical findings are of prime importance, but patients who complain of abdominal pain, rigidity and tenderness should have an upright film taken of the abdomen to rule out the presence of free intraperitoneal gas. If no free gas is seen, an open perforation of the stomach and colon is ruled out. If the pain is in the lower quadrant of the abdomen, a cystogram should be made to rule out a tear in the bladder. If the cystogram and upright film of the abdomen are negative, and if the possibility of rupture of the liver, spleen and kidney are ruled out, the patient should be explored to rule out the possibility of a tear in the small bowel.Injuries to solid viscus are best treated conservatively as long as the patient shows no signs of shock. While the mortality of penetrating wounds to the abdomen is about 50 per cent, the results following surgical treatment are far superior to those following non-interference.The plan of pre- and postoperative care of such patients at the University of Minnesota Hospitals has been briefly outlined.     

腹膜粘连无创评估手段的进展

腹膜粘连是指手术、创伤、腹腔感染、腹膜透析等病因导致的腹腔脏器和组织修复过程中形成的异常的纤维连接。腹部手术是腹膜粘连的最常见原因,绝大多数腹部手术患者术后均会出现不同程度的腹膜粘连。腹膜粘连可以导致患者出现长期的腹痛、诱发肠梗阻,部分患者可能因为粘连带的卡压而出现急性肠坏死。而在女性中,腹膜粘连增加了女性不孕的风险。除此之外,腹膜粘连可以使二次手术变得困难,术中容易出现副损伤。通过无创手段来评估腹膜粘连的程度,筛查腹膜粘连的高危人群,评估药物和屏障材料的临床效果,具有重要的临床意义。超声检查、磁共振电影成像和人工气腹CT能够对腹膜粘连进行精准评估。除此之外,体质量指数、炎症标志物以及赖氨酰氧化酶样蛋白2等指标也对粘连的评估有一定的价值。笔者对目前的腹膜粘连无创评估手段进行综述,以期为临床提供参考。