间接暴力致肝门部放射状损伤

目的 探讨腹部闭合性损伤致肝门部放射状肝破裂的形成机制、临床特点及治疗特点。方法 回顾性总结了1990年8月～2002年9月间8例闭合性腹部外伤致肝门部放射状肝破裂及合并伤的临床表现、治疗方法和结果。结果 8例病人全部经手术治疗痊愈，对胆囊撕脱伤及胆管裂伤患者随访2～3年，无不良反应。结论 肝门部放射状肝破裂由间接暴力所致。可伴有胆囊撕脱伤。肝门胆管、血管及第三肝门裂伤。主要表现为失血性休克，修补肝破裂的同时。注意合并伤的处理。     

小儿腹部闭合性损伤51例临床分析

腹部闭合性损伤是小儿较容易发生的疾病,而且较为凶险,合并伤也较多,我院自1980年至1996年收治51例病儿,现对其分析如下。 临床资料 本组病例男性44例,女性7例,年龄2～14岁,平均6岁。 受伤原因:高处坠落伤35例,交通事故伤17例,其他外伤9例。 受伤部位(包括合并伤):脾破裂18例,其中合并颅骨骨折、颅脑挫伤、脑震荡6例,合并左肱骨骨折及左肩胛骨折1例;肝破裂10例,其中肝包膜下血肿1例,肝破裂合并胸肋骨骨折、右下肺叶挫伤1例,合并右肾裂伤1例;外伤性肠破裂或肠穿孔12例;肾挫伤8例;腹壁挫伤11例,其中有合并伤9例。     

肝外胆道损伤的诊断和治疗

肝外胆道损伤无论在腹部闭合性损伤,还是开放性损伤都很少见,并且肝外胆道损伤的死亡率高达20%。 1967年～1983年期间作者收治了14例肝外胆道损伤患者(男性13例,女性1例),7例是开放伤,7例是闭合伤。其中11例是复合伤,3例是单纯伤。复合伤是:7例肝脏损伤,2例十二指肠损伤,1例脾脏损伤,1例胃损伤,1例小肠及肠系膜损伤。 7例开放伤中6例胆囊损伤,1例系胆总管损伤。7例闭合伤中4例胆囊破裂伤,1例胆总管撕裂伤,1例肝总管破裂伤,1例创伤性坏疽性胆囊炎。作者总结了14例肝外胆道损伤的治疗情况,并提出下列问题讨论:在腹部闭合性损伤中,术前和术     

封闭式负压引流技术联合植皮治疗大面积皮肤撕脱伤合并感染

目的总结封闭式负压引流技术(vacuum sealing drainage,VSD)联合植皮治疗大面积皮肤撕脱伤合并感染的疗效。方法 2010年1月-2011年6月,收治8例大面积皮肤撕脱伤合并感染患者。男2例,女6例;年龄19～70岁。病程5～20 d。闭合性皮肤撕脱伤2例,开放性皮肤撕脱伤6例。创面均累及腰背部、臀部及部分大腿;皮肤坏死均累及皮下脂肪,有脓性分泌物。清创后创面范围为35 cm×15 cm～60 cm×38 cm,行VSD治疗待创面肉芽组织新鲜、血供丰富时进行植皮修复。结果患者经2～3个疗程VSD治疗后,脓腔及死腔封闭,创面肉芽组织生长良好。创面植皮均顺利成活,创面Ⅰ期愈合。术后8例均获随访,随访时间6～12个月,平均9个月。植皮区外观良好,关节功能无障碍。结论 VSD联合植皮是治疗大面积皮肤撕脱伤合并感染的较好方法。     

绷带填塞治疗肝破裂八例报告

我院自 1994～ 1999年采用绷带填塞治疗外伤性肝破裂 8例 ,现报告如下。临床资料一、一般资料 :本组 8例 ,男 5例 ,女 3例 ;年龄3～ 50岁 ,均为闭合伤。单纯肝损伤 5例 ,合并伤 3例。右肝伤 6例 ,左肝伤 1例 ,左右肝同时伤 1例。裂口长 8～ 17ｃｍ ,深 5～ 9ｃｍ ,其中星状裂伤 3例。腹腔积血 30 0～ 350 0ｍｌ,合并休克 7例。二、治疗及结果 :全组病例分别因肝裂口位置深在、破碎、星状裂伤、靠近大血管及病情危重等原因而行绷带填塞 ,其中加明胶海绵和止血宁填塞 6例 ,加大网膜填塞 2例 ,加丝线部分缝合 3例 ,共用绷带4～ 18ｍ ,绷带一头…     

肝外伤24例手术治疗体会

1984年元月至1991年10月,我院采取以大网膜填塞为主的手术方法治疗肝破裂24例,取得满意疗效,现报道如下。临床资料一般资料本组男16例,女8例。年龄7～52岁。24例均为钝性损伤,其中闭合性损伤22例,开放性左上腹壁裂伤并内脏脱出1例。合并伤8例,其中小肠损伤3例,脾脏损伤1例,腹膜后血肿1例,颅脑损伤1例。受伤至手术时间为2～24小时,平均7.5小时。     

腹部双叶单蒂薄皮瓣修复多指套状撕脱伤

多指套状撕脱伤是手外科中常见的严重性损伤 ,如伴肌腱、骨外露则处理更为困难。以往采用腹部埋藏或腹部皮瓣修复术 ,但需多次手术且修复后患指功能差。 1997年 2月～2 0 0 0年 6月 ,我科采用以腹壁浅血管及旋髂浅血管为单蒂的腹部双叶薄皮瓣修复多指套状撕脱伤 6例 ,效果满意。　　一、资料与方法　　 1.一般资料 :本组共 6例 ,男 5例 ,女 1例 ;年龄 18～ 41岁 ,平均 2 9.8岁。伤情 :轧面机碾压伤 3例 ,其中 3指撕脱伤 1例 ,2指撕脱伤 2例 ;机器绞伤 2例 ,4指撕脱伤 1例 ,2指撕脱伤 1例 ;车祸碾压撕脱伤 1例为 2指撕脱伤。均用下腹部真皮下…     

外伤性胆道损伤治疗体会

目的总结外伤性胆道损伤的诊断及治疗经验。方法回顾性分析我院2000-2014年收治的10例外伤性胆道损伤患者的临床资料,对诊断和治疗方法进行分析。结果外伤性胆道损伤10例,其中胆囊破裂1例,胆囊重度挫伤1例,左肝管损伤4例,肝(胆)总管损伤3例,胆总管撕脱伤1例。合并肝破裂5例,肝挫伤2例,十二指肠破裂、胰腺断裂1例,门静脉损伤1例,股骨骨折1例。8例急诊剖腹探查术中诊断,2例在伤后17 d和32 d出现腹膜炎剖腹探查诊断。行胆囊切除术2例,左肝管修补+胆总管T管4例,肝(胆)总管修补+T管引流2例,胆总管切开探查+T管引流1例,胆总管+胰管引流1例。9例痊愈,1例死亡。结论熟悉外伤性胆道损伤的特点,早期诊断和确定性治疗,是外伤性胆道损伤救治成功的关键。     

闭合性十二指肠损伤的诊治对策

闭合性十二指肠损伤多为复合伤 ,诊断及处理比较困难 ,死亡率高。我院近 15年来诊治十二指肠损伤病人 11例 ,报告如下。临床资料1.一般资料 :本组共 11例 ,男 10例 ,女 1例 ;年龄 18～ 4 5岁 ,平均 31岁。受伤原因 :车祸伤 8例 ,腹部撞击伤 2例 ,高空坠落伤 1例。损伤部位 :十二指肠上部 2例 ,降部 6例 ,水平部 2例 ,升部 1例。损伤裂口 :0 .5～ 2 .5cm 7例 ,3～ 4cm 3例 ,断裂 1例。合并伤 :肝破裂 3例 ,脾破裂 1例 ,右肾挫伤 2例 ,胃大网膜伤 2例 ,小肠破裂 1例 ,后腹膜血肿 8例。2 .治疗方法 :在抗休克和对症处理后作急诊剖腹探查。除 3…     

外伤性胰腺损伤30例诊治体会

我院1986年至1996年共收治腹部外伤815例，其中胰腺损伤30例，男26例，女4例。年龄10～68岁，平均55岁。闭合性损伤28例，开放性损伤2例。交通事故伤22例，砸伤6例，刀刺及枪弹伤各1例。损伤位于胰头12例，胰颈5例，胰体8例，胰尾5例。胰腺离断伤4例，裂伤20例，挫伤6例，胰管损伤8例。合并腹内其他脏器伤24例，肝脾损伤13例，十二指肠损伤6例，胃损伤3例，胆囊损伤1例，肾损伤2例，腹膜后大血管损伤2例。     

Complications following repair of extrahepatic bile duct injuries after blunt abdominal trauma

Extrahepatic bile duct traumatic injuries are extremely rare and their treatment is difficult and with several controversies. The aim of this study was to offer some more clinical information on their surgical repair and outcome. We present seven patients with extrahepatic biliary tract lesions after blunt abdominal trauma, (isolated gallbladder lesions were excluded) four males and three females from 23 to 51 years of age (mean age 35.1 years). All patients had suffered high-energy blunt abdominal trauma and presented associated injuries, mostly liver trauma and lung contusions. Six gallbladder lesions and six common bile duct injures were identified; a right hepatic duct laceration and a left hepatic duct transection were also present. Injuries were treated either with primary repair or with duct-jejunal anastomoses with Roux-en-Y reconstruction. Principal complications were postoperative anastomotic leakage (1 case) and recurrent cholangitis (3 cases) with or without stricture. Not-diagnosed injuries caused substantial morbidity. We prefer and recommend the use of primary repair in partial ruptures with no significant tissue loss and biliary-enteric anastomoses in large injuries and complete transections because they offer the best long-term drainage with less risk of stricture formation than end-to-end anastomoses. We defend the use of long duration (6 to 9 months) transanastomotic stents.     

Characteristic features of abdominal organ injuries associated with gastric rupture in blunt abdominal trauma

BACKGROUND: Previous studies have investigated the mechanisms of gastric rupture based only on the findings in gastric rupture and excluding gastric lacerations. METHODS: We investigated 14 cases of gastric injury (five with rupture and nine with laceration) from blunt abdominal trauma with or without thoracic trauma. Gastric injuries were caused by a traffic accident in 12 and by a fall in two patients. All of the patients with gastric rupture had had a full stomach at the time of impact. RESULTS: The patients had associated injuries of adjacent solid organs, the thoracic cage, and extremities. The frequency of injury of the hepatoduodenal or gastrohepatic ligament was higher in patients with gastric laceration than in patients with gastric rupture. Eight of nine patients with a gastric laceration had hepatic or pancreatic injury, whereas none of the patients with gastric rupture had such injury. CONCLUSIONS: The results of our study showed that the distended stomach tends to rupture by absorbing the impact from blunt abdominal trauma (i.e., it works like an airbag to protecting adjacent organs such as the liver and pancreas).     

Traumatic Duodenal Rupture and Avulsion of the Ampulla of Vater

Duodenal injury following blunt abdominal trauma is uncommon. The severity of injury can vary from an intramural haematoma to a duodenal rupture with associated transection of the pancreatic duct. A case of duodenal rupture with avulsion of the ampulla of Vater is presented and discussed.     

Porta hepatis disruption from blunt trauma

Extrahepatic porta hepatis injuries from blunt abdominal trauma are exceedingly rare; all recently reported cases involve disruption of the common bile duct at its intrapancreatic portion. We herein report a patient with lacerations of the proper hepatic artery and bile duct occurring from deceleration/torsion of the porta hepatis after high speed vehicular collision.     

创伤性肝胆管损伤的外科处理

目的探讨创伤性肝胆管损伤的处理方法。方法回顾性分析近10年我院收治220例肝创伤中12例肝胆管损伤患者的临床资料：结果除外院转入1例因来院过晚,失去手术时机衰竭死亡外,另11例均获痊愈：其中7例再手术治疗：1例持续胆漏予以近端漏口缝扎,胆总管引流;3例因反复发作化脓性胆管炎、梗阻性黄疸,行胆管空肠Roux—Y吻合术：另3例伴有肝萎缩、创伤性胆道出血分别行肝段、叶切除术。尚有4例胆漏维持通畅引流．亦获满意结果．于2周内停止胆漏。结论肝创伤合并肝胆管损伤,经初期和后期认真处理,均可获得良好预后．     

Endoscopic Management of Perforation of Right Hepatic Duct Following Non-Surgical Abdominal Trauma

Isolated bile duct injuries after blunt abdominal trauma are rare. Surgery is the usual mode of treatment. We report a patient with a right hepatic duct injury following blunt abdominal trauma who was managed successfully by endoscopic papillotomy.     

Intrahepatic bile duct rupture following blunt abdominal trauma

The natural history of intrahepatic bile duct rupture secondary to blunt trauma is not known. A unique case of bilateral hepatic lobar duct rupture is presented to demonstrate the clinical features and potential complications of this injury. Operative intervention is not always indicated and treatment should be dictated by the specific lesion.     

Conservative management of hepatic duct injury after blunt trauma: a case report

Nonoperative management of solid organ injury in children with blunt abdominal trauma represents the standard of care. In rare cases, a major duct injury with persistent bile leakage may result from blunt trauma to the liver. This injury is of concern in patients treated nonoperatively because it generally must be treated with major abdominal surgery. The authors describe a case of hepatic duct injury from blunt trauma in which healing occurred without surgical repair or resection.     

外伤性胆道损伤的处理

目的 探讨外伤性胆道损伤的处理方法.方法 回顾性分析2009年7月至2014年5月华中科技大学同济医学院附属同济医院收治的26例外伤性胆道损伤患者的临床资料.26例患者均有外伤史.根据损伤控制原则,行剖腹探查术明确诊断后,根据术中探查情况,采用Mattox损伤分型标准对患者进行分型.在抗休克治疗的同时,根据损伤部位和程度,选择胆囊切除术、胆管修补术、胆管对端吻合术、胆肠吻合术和肝方叶切除＋肝门部胆管整形＋肝肠吻合术等手术方式.合并其他脏器的损伤者均行相应的手术治疗.术后辅以抗炎、补液等对症支持治疗.记录患者院内死亡情况.出院患者定期门诊或电话随访,随访时间截至2014年10月.结果 26例患者行剖腹探查术,术中发现胆囊损伤15例、胆总管损伤5例、肝总管损伤3例、左肝管损伤2例、右肝管损伤1例;合并肝破裂11例、脾破裂1例、肾破裂5例、小肠破裂4例.Mattox损伤分型：Ⅰ型11例,Ⅱ型4例,Ⅲ型0例,Ⅳ型8例,Ⅴ型3例.15例胆囊损伤患者中,5例Ⅰ型胆囊挫伤较轻者未行胆囊切除术,6例Ⅰ型胆囊挫伤较重者和4例Ⅱ型患者行胆囊切除术;11例肝胆管损伤患者中,5例Ⅳ型较轻者行胆管修补＋T管引流术,3例Ⅳ型较重者根据损伤部位采用不同手术方案（1例行胆管对端吻合术＋T管引流术、1例行胆肠吻合术、1例行肝方叶切除＋肝门部胆管整形＋肝肠吻合术）,3例Ⅴ型患者均行胆肠吻合术.合并其他脏器损伤的患者均行相应的手术治疗：11例联合肝破裂修补术或肝段切除术,1例联合脾切除术,5例联合肾切除术,4例联合小肠部分切除＋端端吻合术.26例患者中,术后1例因失血性休克经抢救无效于住院期间死亡;3例出现胆汁漏,1例出现伤口感染,经对症支持治疗后痊愈.25例患者治愈出院.25例患者获得随访,随访时间为术后1、3、6、12个月,无一例患者发生迟发性胆?     

Biliary stricture due to neuroma after an innocent blunt abdominal trauma

A traumatic neuroma of the biliary tract is rarely associated with biliary obstruction. However, when it arises in the common bile duct (CBD) and is associated with obstructive jaundice, it is difficult to distinguish it from bile duct cancer. We describe a patient who developed obstructive jaundice and itching, due to CBD stricture, 8 years after innocent blunt abdominal trauma. The stricture was resected and hepatico-jejunal anastomosis was performed. Histological examination revealed a traumatic neuroma and a fibrous scar around the common bile duct. Symptoms disappeared following surgical removal of the lesion. Blunt abdominal injury may cause the late onset of a fibrous scar and traumatic neuroma in the common bile duct. To our knowledge, a traumatic neuroma of the biliary tract after blunt abdominal trauma has not been reported previously. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis and treatment.