胸腹部多发伤48例诊治分析

胸腹部多发伤伤情严重复杂,临床上诊断和治疗均较困难。我院自1990年10月～1999年9月共收治48例,取得较好疗效,总结如下。临床资料1　一般资料本组共48例,男39例,女9例;年龄12～70岁,平均41岁。刀刺伤9例;钝性伤39例,其中交通事故伤18例,煤矿工伤11例,坠落伤4例,重物砸伤6例。入院时合并休克23例(48%),呼吸困难21例,血气胸26例,腹膜炎28例。2　治疗情况及损伤脏器48例中经腹手术30例,经胸手术4例,分别经胸、腹径路手术6例,8例仅行单纯胸腔闭式引流。本组共有组织器官损伤121处,其中多发性肋骨骨折42例,肺挫裂伤25例,心脏破裂1例,支气管损伤2…     

钝性胸腹部损伤60例分析

我院1976年以来收治60例胸腹部损伤患者，现总结如下。     

胸腹部螺纹钢筋贯通伤救治成功2例

报道2例胸腹部螺纹钢筋贯通伤救治成功病例,探讨胸腹部贯通伤的应急处理措施和协助救治的体会.     

罕见胸腹腔贯通伤2例抢救体会

报告2例罕见胸腹腔贯通伤的抢救经验,探讨遭遇这种贯通伤的应急处理程序及综合协调处理能力。     

胸部锐器贯通伤56例诊治体会

对56例胸部锐器贯通伤的诊断治疗进行回顾性分析研究，认为应及早诊断治疗，准确判断病情，优先处理致命伤，重视复合伤救治，能取得较好的治疗效果。     

严重胸腹部多发伤41例临床救治分析

总结胸腹部多发伤的诊断与治疗经验。认为早期诊断、迅速救治是减少并发症,降低死亡率的关键。     

枪击致胸腹联合伤救治1例

2008年6月18日,我们在利比里亚维和期间,救治埃塞俄比亚籍军人被枪击致胸腹联合伤1例。现分析报告如下。 1病例报告 患者男,31岁。受枪击10min后入院。查体：脉搏108／min、细弱,呼吸32次／min,血压70／50mmHg,血氧饱和度0．86。     

胸贯通伤34例诊治体会

胸贯通伤常造成肺、心脏、大血管等重要脏器的损伤而危及生命。 1993年 1月～ 2 0 0 2年 1月 ,我院共收治 34例 ,抢救成功 32例。1　临床资料1 1　一般情况　 34例中 ,男 2 5例 ,女 9例 ;年龄 6 4～ 17岁 ,平均 34 6岁。均于伤后 2 4h内入院。致伤原因 :车祸 15例 ,刀刺伤 16例 ,其他原因 3例。受伤情况 :血气胸 2 6例中 ,肺裂伤 14例 ,心脏损伤2例 ,胸主动脉破裂 1例 ,膈肌破裂 3例 ,胃、脾破裂各 1例 ,合并颅脑外伤及四肢骨折各 2例。少量血胸 6例 ,左右胸腔贯通伤 2例。1 2　临床表现及诊断　伤后均有胸痛 ,出现胸闷、气急 2 8例 ,早期出…     

胸腹联合伤37例诊治

分析37例胸腹联合伤的临床特点和救治经验,存活33例,死亡4例。胸腹联合伤死亡率高,常见死因为失血性休克;手术入路视情况而定;早期诊治是提高治疗效果的关键。     

腹部贯通伤致输尿管损伤漏诊1例报告

病例　李某 ,男 ,18岁 ,某部战士 ,在演习中不慎被手枪弹击中左下腹 ,子弹从右臀上部穿出。伤后即送往团卫生队行抗休克、留置尿管、剖腹探查术等处理 ;探查术中见小肠及肠系膜多处破裂 ,腹腔内有大量积血及肠内容物 ,总量约 30 0 0m1,清除积血及肠内容物后行小肠修补术、肠系膜修补术放置腹腔引流管两根 ,伤后 3d后因出现呕吐、腹胀、尿量少 ,由团卫生队转送我院普外科 ,经胃肠减压处理后肠梗阻症状缓解 ,同时发现腹腔引流管内引出大量清亮液体约 2 70 0ml/d ,导尿管内引出的尿量少 ,查腹腔引流液中BUNl2 6mmol/L、尿中BUN16 4mmol/L ,…     

尖刀致颅脑贯通伤2例分析

对2例尖刀致颅脑贯通伤并刀具存留患者行手术取出刀具及清创治疗,均采用沿刀刃旁入路,将伤道及刀尖周围的脑组织探查清楚后,仔细缓慢退出刀具后以抗生素盐水冲洗伤道.2例患者均成功拔出刀具,术后恢复良好,未出现重要神经功能障碍.     

钝性伤所致心脏瓣膜损伤3例报告

本文回顾分析了3例钝性伤所致心脏瓣膜损伤,均进行了手术治疗,并全部治愈出院。讨论钝性伤所致心脏瓣膜损伤的诊断及漏、误诊可能存在的因素,心脏听诊、X线、超声心动图检查三者联合应用是提高心脏瓣膜损伤诊断及减少漏、误诊的重要手段。     

地震掩埋致特重软组织损伤特点及救治

目的：探讨地震掩埋所致特重软组织损伤的特点及救治策略。方法：收集汶川大地震期间我院收治的5例特重软组织伤病员的临床资料,分析其伤情特点、救治过程和效果。结果：地震所致软组织伤具有受伤部位多;皮肤损伤范围小于肌肉损伤;致残率、并发症发生率高的特点。结论：应早期紧急处理;防治全身炎症反应综合征;多次清创去除坏死组织;最大限度的保护肢体功能;及时有效的心理干预。     

209例肝脏损伤的院内救治

目的：探讨创伤性肝破裂的院内救治效果。方法：总结1989－1999年第三军医大学三所附属医院收治的肝破裂209例，其中Ⅲ级以上严重肝损伤108例（51．7％）。手术治疗186例，伤后至手术时间165min-16h，保守治疗23例。结果：手术治愈169例（90．9％），死亡17例（9．1％），有18例发生并发症，保守治愈22例（95．7％），死亡1例（4．3％）。结论：伤情严重和治疗延迟是导致肝外死亡的两大因素，外科手术仍是治疗肝破裂的主要措施，保守治疗应严格掌握适应征。     

Penetrating liver war injury: a report on 172 cases

During the 4-year military conflict in Croatia, we treated operatively 7,928 casualties. Of those casualties, 172 (2.2%) had penetrating liver injury, mostly sustained by explosive devices. Of these injuries, 90.7% were associated with the trauma of other abdominal and extra-abdominal organs. Seventy-five percent of injuries belonged to grades III and IV on the Liver Injury Scale. The main method of treatment was debridement with ligation of severed vessels and bile ducts. In 8.1% of cases with detrimental bleeding, we used liver packing. Fifty percent of these patients have survived but with a high incidence of septic complications. This method was proven salutary in the most detrimental injuries that could not be treated in any other way. Postoperative hemorrhage and intra-abdominal abscesses were complications that needed surgical and ultrasound-guided aspiration, respectively. Numerous heavy injuries of the liver combined with associated trauma of other vital organs are responsible for the high mortality rate of 28.5%.     

Coil embolization of intradural pseudoaneurysms caused by arterial injury during surgery: report of two cases

Intradural pseudoaneurysms arose in two patients as a result of arterial injury incurred during surgery. In the first patient, the pseudoaneurysm developed in the middle cerebral artery, at the site of vessel perforation during aneurysmal surgery. In the second patient, the pseudoaneurysm developed in the anterior communicating artery after removal of a tuberculum sellae meningioma. These aneurysms had small ostia and were successfully embolized with electrolytically detachable coils. The clinical features and the treatment of intracranial pseudoaneurysms are discussed.     

钝性肝破裂151例治疗分析

分析总结钝性肝破裂的治疗体会。外科手术仍是钝性肝破裂的主要治疗措施,保守治疗应严格掌握适应证。     

Ureteral avulsion caused by through and through penetrating injury of the pelvis

Ureteral avulsion is one of the rare cases in urology considering that this structure is well-protected in retroperitoneal location. However, the presence of penetrating pelvis injury should raise high clinical suspicion that ureteral avulsion may present in this case. We report the case of ureteral avulsion in patients caused by through and through penetrating injury of the pelvis. We managed ureteral avulsion by performing end-to-end anastomosis along with ureteral stenting. A multidisciplinary approach was performed to treat other structural damages. Finally, after two months, ureteral stent was removed and ileal-re-anastomosis was performed.     

Intracranial penetrating injury by screw driver: A case report and review of literature

Penetrating injury to the head, with the exception of missile injuries is rare owing to thick calvarium. Orbital and temporal areas are comparatively vulnerable to penetrating injuries, due to their relative thinness. A case is presented in which a man killed his wife by forcefully thrusting a screw driver into her cranial cavity. The deceased presented to the hospital with the screw driver embedded in her head. She was declared as ‘brought dead on arrival’ at the emergency of the hospital. Pre-autopsy plain radiography and Computed Tomography (CT) of the head were done to assess the extent of brain damage. The peculiarity of this case lies in the fact that screw driver as a stabbing weapon in the head is very rarely used. In such cases, there is a need to perform radiography and CT with the weapon in-situ for better interpretation on injuries. In this paper role of radiography and CT in intra cranial penetration is discussed with review of literature.     

直肠损伤致肛管闭锁的教训

报道 1例外伤性骨盆骨折、后尿道断裂、直肠破裂 ,先后 2次手术 ,术后 3个月发现直肠完全闭锁。笔者总结 :(1)骨盆骨折的病人应考虑有直肠刺伤的可能 ;(2 )患者住院及出院均应协助、指导定期行扩肛并定期检查