外伤性肝破裂52例诊治体会

目的分析肝脏外伤的特点及其诊治方法。方法对1996年1月-2005年12月年本院收治创伤性肝破裂52例进行回顾性分析。其中Ⅲ级以上的严重肝破裂37例。手术治疗51例,手术方式包括单纯修补、清创性肝切除、肝周填塞止血:非手术治疗1例。结果:手术组:治愈49例,术后死亡2例:非手术组1例治愈结论:I级单纯性外伤性肝破裂可保守治疗;手术是治疗创伤性肝破裂的主要措施。确切止血,仔细结扎胆管,充分通畅的引流及术后抗生素扣支持治疗是防止并发症的关键。     

外伤性肝破裂50例诊治分析

目的 探讨外伤性肝破裂的诊断方法及有效治疗方式。方法 回顾性分析我科2005年1月～2010年l月收治的50例外伤性肝破裂患者的临床资料。结果39例患者给予手术治疗,治愈37例,治愈率为94％;11例患者给予非手术治疗,均痊愈。死亡2例,总死亡率为4.0％,其中1例死于术中难以逆转失血性休克,1例死于并发多器官功能衰竭死亡。结论 肝损伤者病情急,及时诊断及合理治疗是提高治愈率、降低死亡率的关键。严格掌握好非手术治疗的适应证,在严密监测生命体征前提下,进行积极的非手术治疗具有很好的临床效果。     

外伤性肝破裂77例临床分析

目的总结外伤性肝破裂诊治体会,提高外伤性肝破裂的外科治疗水平。方法对77例外伤性肝破裂患者的临床资料进行回顾性分析。结果本组77例中非手术治疗11例,全部治愈。66例根据肝外伤的不同分级,采用不同的手术方式治疗。其中治愈58例。手术后发生并发症9例(13.6%),死亡8例。结论早期诊断、准确评估伤情,合理选择治疗方式,并对具备手术指证患者及时实施手术治疗,是提高外伤性肝破裂的治愈率,降低病死率的关键。     

外伤性肝破裂46例临床治疗体会

目的探讨外伤性肝破裂的诊断和治疗过程中应注意的问题。方法回顾性分析2008年10月至2012年1月我院46例外伤性肝破裂的治疗方法和结果。结果本组患者46例,其中非手术治疗5例,均治愈;手术治疗41例,其中死亡2例,治愈39例。讨论早期诊断、准确的评估伤情,合理选择非手术治疗和手术治疗,是提高外伤性肝破裂的治愈率,降低死亡率的关键。     

肝破裂96例诊治分析

目的探讨肝破裂的诊治方法。方法回顾性分析我院自1990年-2005年期间96例肝破裂的治疗经过。结果 96例肝破裂中,治愈91例(治愈率94．8％),死亡5例(病死率5．2％),非手术治疗8例,均治愈。各种手术治疗88例,并发胆瘘4例,膈下感染5例,肝脓肿3例,均保守治愈。死亡病例中合并胸外伤者死亡2例,合并脑外伤者死亡1例,1例Ⅴ级肝外伤和1例Ⅵ级肝外伤因严重的失血性休克及术后继发多器官功能衰竭死亡。结论保守治疗要严格掌握适应证。手术治疗要根据肝破裂的具体状况选择不同的手术方式。要重视合并伤的积极处理。     

62例外伤性肝破裂的诊治分析

目的探讨外伤性肝破裂的诊断和治疗方法,提高严重病例生存率。方法回顾性分析62例外伤性肝破裂患者的诊治经过．总结外伤性肝破裂的诊断流程、手术或非手术治疗的适应征、手术术式的具体选择方法。结果62例患者中,非手术治疗40例＋手术治疗22例,死亡8例,死亡率为13％。结论外伤性肝破裂应早期明确诊断,在积极液体复苏和严密监测的条件下,部分病例可通过非手术治疗获得成功;手术治疗的严重病例,选择简单有效的损伤控制性手术（DCS）至关重要。     

外伤性肝破裂84例治疗分析

目的探讨外伤性肝破裂基层医院治疗方法。方法对本院2000年3月至2013年11月期间,收治的84例外伤性肝破裂患者的l艋床资料进行回顾性分析。结果本组患者共84例,治愈78例,死亡4例,转院2例。非手术治疗26例,其中2例中转开腹手术,手术治疗共58例,其中死亡4例,发生胆汁漏及肝脓肿9例。结论外伤性肝破裂实施个体化治疗及基层医院对严重肝损伤病例行肝周填塞法有较大的临床价值。     

34例创伤性肝破裂的外科治疗体会

目的探讨创伤性肝破裂救治的最佳措施。方法对2003年1月2009年1月间收治的34例外伤性肝破裂病例的诊断、治疗方法及其预后进行回顾性分析。结果4例行非手术治疗,30例手术治疗,治愈30例。术后并发切口感染者2例,胆漏2例,膈下感染1例,死亡4例,死亡率为11．8％,主要死因为失血性休克。结论综合选择手术术式可以明显提高手术成功率及减少并发症和死亡率。     

严重外伤性肝破裂诊治体会:附49例报告

目的：探讨外伤性肝破裂的诊断和治疗方法。方法：回顾性分析9年间收治的49例III~VI级外伤性肝破裂患者的临床资料。结果：均采取手术治疗。术后出现并发症9例,并发症率18.4%;治愈42例,治愈率85.7%;死亡7例,病死率14.3%。主要死亡原因为无法控制的大出血,严重合并伤及严重失血性休克。结论：诊断性腹穿和床旁B超是外伤性肝破裂的重要诊断方法。及早诊断,积极手术,采用恰当的围手术期处理及合理的手术方式,可提高抢救成功率。     

外伤性肝破裂的诊断及治疗选择

目的探讨外伤性肝破裂的诊断及治疗方法。方法回顾性分析我院1997年3月至2007年3月间收治的128例外伤性肝破裂患者的病例资料。其中闭合性损伤102例,开放性损伤26例;保守治疗15例,手术治疗113例。结果治愈123例(治愈率为96.1%),5例死亡,死亡原因为失血性休克及多脏器功能衰竭。结论外伤性肝破裂应及时诊断制订合理的治疗方案,对严重的肝外伤选择正确的手术方式是治疗的关键。     

创伤性肝破裂的外科治疗体会

目的探讨创伤性肝破裂院内救治的最佳措施。方法回顾性分析43例创伤性肝破裂的临床资料。结果2例行非手术治疗,41例手术治疗,治愈36例。术后并发切口感染者3例,胆漏1例,膈下感染1例,死亡7例,死亡率为16.3%,主要死因为失血性休克。结论手术是治疗创伤性肝破裂的主要方法,术中选择正确的手术方式是提高创伤性肝破裂疗效的关键。     

20例创伤性结肠破裂一期手术治疗临床分析

【摘要】〓目的〓探讨结肠破裂I期手术治疗的可行性,总结手术治疗的体会。方法〓本组共20例,均为外伤所致,破裂范围小于1/2肠管周径。创缘常规清创后进行I期修复18例,2例大于2 cm的挫裂伤行Ⅰ期肠管切除吻合。结果〓实施Ⅰ期手术治疗的20例患者中,术后1例患者出现肠瘘,后经引流、积极治疗等传统治疗后于术后1个半月痊愈,2例患者出现切口感染,伤口换药后于1个月痊愈。结论〓创伤性结肠破裂患者实施Ⅰ期手术治疗需要严格的适应症选择、术中正确判断及恰当的术后围手术期处理。     

Severe hepatic trauma：surgical strategies

Objective:To probe into effective surgical procedures and improve the outcome of treatment for patients with severe hepatic injury.Methods:A retrospective study involving 113 patients with severe hepatic trauma(AAST grade IV and V) during the past 12 years was carried out.Ninety-eight patients underwent surgical treatment.Surgical interventions including hepatectomy or direct control of bleeding vessels by finger fracture technique with Pringle maneuver, selective ligation of hepatic artery,retrohepatic caval repair with total hepatic vascular occlusion,and perihepatic packing were mainly used.Results:In the 98 patients treated operatively,the survival rate was 69.4%(68/98).Among 40 patients with juxtahepatic venous injury(JHVI),15 were cured with the maximum blood transfusion of 12 000 ml.Eight cases of Grade IV injury treated nonoperatively were cured.The percentage of failure of nonoperative management was 42.9%(6/14).The overall mortality rate was 32.7%(37/113),and 57% of the deaths were due to exsanguinations.Conclusions:Reasonable surgical procedures based on classification of hepatic injuries can increase the survival rate of severe liver trauma.Accurate perlihepatic packing is effective in dealing with JHVI.     

肝外伤选择不同术式意义的探讨

目的探讨不同术式综合应用对不同程度不同类型肝外伤的治疗效果。方法分析我院1998年1月至2004年11月经手术治疗肝外伤49例的手术方式:肝缝合修补术7例;肝修补加门静脉裂口修补1例;肝动脉结扎加肝缝合修补3例;肝切开缝扎术(应用手指折断技术即FFT肝造口选择性血管胆管缝扎,缝合肝裂口)17例;清创性肝切除18例,其中5例另行肝右静脉缝扎,3例另行肝右静脉缝扎加肝后下腔静脉修补;规则性肝切除3例(右半肝2例,左外叶1例),其中2例另行肝后下腔静脉修补。结果除3例术前因重度休克,术中出现不可逆DIC,术后因MODS死亡外,其他病例均抢救成功,死亡率6.12%,无严重术后并发症。结论正确的术式选择是提高严重肝外伤疗效的关键。手术过程不能局限于肝表面止血,肝内管道处理更为重要;肝切开缝扎术及清创性肝切除术适用于大宗肝外伤病例。     

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...     

Emergency Treatment of Acute Rupture of the Descending Thoracic Aorta Using Endovascular Stent-Grafts

Open surgical management of acute rupture of the descending thoracic aorta (DTA) is associated with high mortality and morbidity. Endovascular stent-grafts (ESGs) could provide a less invasive treatment alternative to conventional open surgery. The purpose of this report detailing our experience using ESG for treatment of acute rupture of the DTA is to determine the indications for endovascular repair. From June 2000 to April 2005, 17 patients presenting rupture of the DTA were treated using commercially available ESGs at our institution. There were two women and 15 men, with a mean age of 41.9 +/- 20.5 years. The cause of aortic rupture was traumatic in 13 cases and nontraumatic in four. Treatment was undertaken immediately in 10 cases and delayed in seven (range 5-68 days, mean 23.5). In one patient, the proximal neck landing zone was prepared prior to endovascular repair. No patients died during the postoperative period. The technical success rate was 84%. One patient developed a proximal type 1 endoleak at the end of the procedure. Three complications, i.e., two iliac dissections and one femoral artery rupture, occurred during the procedure. No paraplegia was observed. Mean follow-up was 13.3 months (range 1-41). One patient treated for traumatic rupture was lost from follow-up 21 months after initial treatment. No procedure-related complication was observed in this traumatic rupture group. Control computed tomographic scan at 13 months following the procedure demonstrated no evidence of periprosthetic leak or false aneurysm. In the nontraumatic rupture group, two patients died of aortic rupture and one treated for aortobronchial fistula developed recurrent hemoptysis 23 months after initial treatment and required placement of two additional ESGs. The immediate outcome of covered stent-graft placement for management of acute aortic rupture of the DTA is good. However, long-term surveillance is mandatory, especially in patients treated for nontraumatic aortic rupture that is associated with a high late complication rate. Further study will be needed to determine the exact utility of endovascular therapy for aortic rupture: final treatment or bridge to conventional open-chest repair when the patient's condition has stabilized.     

创伤性膈疝25例临床诊治体会

目的总结创伤性膈疝的临床诊断和早期治疗的经验,为减少误诊、漏诊及提高治愈率提供参考。方法对25例创伤性膈疝患者的临床资料与治疗经验进行总结分析,21例于伤后24 h内就诊,3例于伤后48h就诊;1例CT检查发现空腔脏器疝入胸腔,追问病史,2年前有外伤史。术前均完善胸片、胸腹部CT和胸腹部B超检查,术前均获确诊,确诊率100%。采用经胸手术14例,经腹手术8例,胸腹联合切口3例。疝内容物为肝3例,脾6例,胃7例,大网膜4例,结肠2例,其他3例。同时行肝修补术3例,行脾切除术6例,行胃肠破裂修补术13例。结果术中发现左侧膈疝23例,右侧膈疝2例。膈肌呈线性破裂20例,呈不规则破裂5例。膈肌破裂长度平均为7.6(4～16)cm。治愈23例,死亡2例,病死率8%。23例均获随访,平均随访时间28.5(6～40)个月,未见膈疝复发。结论创伤性膈疝多发生于严重胸腹部损伤,缺乏特异性临床表现,一经确诊应尽早手术治疗。修补膈肌裂口,及时正确地处理合并脏器伤是提高治愈率,降低死亡率的关键。     

Traumatic rupture of the thoracic aorta: ten years of delayed management

OBJECTIVE: Traumatic rupture of the thoracic aorta is a highly fatal condition in which patient outcome is strongly conditioned by other associated injuries. Delayed aortic treatment has been proposed to improve results. METHODS: The charts of 69 patients with traumatic rupture of the thoracic aorta observed between 1980 and 2003 were reviewed. Patients were grouped according the timing of repair: group I, immediate repair (21 patients); and group II, delayed repair (48 patients). In group II, 45 patients were treated surgically or by endovascular procedure. RESULTS: In-hospital mortalities were 4 of 21 patients (19%) in group I and 2 of 48 patients (4.2%) in group II. There were 3 cases of paraplegia in group I and none in group II. CONCLUSION: Improvement of patient outcome with traumatic rupture of the thoracic aorta can be achieved by delaying surgical repair until after management of major associated injuries if there are no signs of impending rupture. Endovascular treatment is feasible and safe and may represent a valid alternative to open surgery in selected cases.