迟发性脾破裂13例诊治体会

我院自 1980年～ 1999年间共收治了迟发性脾破裂 13例 ,现将其诊治体会报告如下。1　临床资料本组男 12例 ,女 1例 ,年龄最大 4 7岁 ,最小 19岁。受伤原因 :交通事故 8例 ,击伤 4例 ,跌伤 1例 ,13例均为腹部闭合性损伤 ,伤后出现脾破裂症状 ,4 8ｈ至2周内 12例 ,18ｄ1例 ,出血性休克 7例 ,左上腹痛 13例 ,局部压痛、肌卫、反跳痛 10例 ,合并胸部挫伤、左肋骨骨折 5例 ,腹穿抽出不凝血者 7例 ,腹部Ｘ线检查 9例为脾影增大、模糊、左膈动度下降。 11例行脾切除术 ,2例行脾修补术 ,平均住院 16ｄ。2　讨论迟发性脾破裂又称脾包膜下破裂 ,延迟性…     

创伤性脾被膜下血肿诊治体会

目的:探讨创伤性脾被膜下血肿与延迟性脾破裂关系.方法:对68例创伤性脾被膜下血肿病例进行回顾性分析.结果:68例创伤性脾被膜下血肿病人中有15人发生延迟性脾破裂(占22%),均进行手术治疗,全部治愈.结论:创伤性脾被膜下血肿与延迟性脾破裂关系密切.     

延迟性脾破裂28例临床分析

延迟性脾破裂病死率比一般脾破裂高10倍,且并发症多,因此,延迟性脾破裂的早期确诊和积极治疗显得尤为重要。我院1986~1996年共收治外伤性闭合性脾破裂184例,其中延迟性脾破裂28例,现分析如下。临床资料28例中男性21例,女性7例。年龄最小17岁,最大64岁,平均年龄38岁。致伤原因,坠落伤11例,击伤13例,车祸伤3例,机器轧伤1例。伤后出现脾破裂症状的时间,2~7天16例,8~14     

延迟性脾破裂的诊治体会

延迟性脾破裂是外伤性脾破裂的一种特殊类型，系指腹部外伤48h以后才表现腹腔内大出血症状的脾破裂，它不仅指包膜下脾破裂出血，还包括脾破裂后脾周围血块脱落继发出血和脾脏裂孔小、出血缓慢者。我院自1978年1月～1997年4月，共收治外伤性脾破裂125例，其中延迟性脾破裂19例。现报道如下。     

延迟性脾破裂21例临床分析

延迟性脾破裂(DRS)是外伤性脾破裂的一种特殊类型,系由中央型脾破裂和包膜下破裂发展而成的真性破裂。早期症状隐匿,病情急,变化快,并发症和病死率均高于一般脾破裂。我院1987年1月～2001年10月共收治延迟性脾破裂21例。结合文献分析报告如下。     

13例外伤性延迟性脾破裂临床分析及诊治体会

目的：探索外伤性延迟性脾破裂疾病的发病因素、临床症状、诊断和治疗方式。方法：分析于我院接受治疗的患者相关临床数据资料。结果：接受治疗的13例患者均是闭合伤，发病在48h后，经过腹腔穿刺、CT和B超检查均确证为外伤性延迟性脾破裂。都接受手术治疗方式，其中行脾切除手术为8例、脾部分切除手术为3例、脾修复手术2例，最终均已治愈出院。结论：延迟性脾破裂病症发生缓慢，很容易误诊。所以诊断时需谨慎依靠病史和临床表现，更需要通过各项检测方式来诊断，根据病情和脾破裂程度选择正确的手术方式。     

延迟性脾破裂23例诊治分析

目的：分析延迟性脾破裂的发病机制及诊治方法。方法：对23例延迟性脾破裂病例进行回顾分析。结果：本组23例患者手术治疗19例,其中脾切除14例,脾部分切除2例,脾修补术2例,自体脾片网膜内移植1例,保守治疗4例,全部患者均痊愈出院。结论：提高对延迟性脾破裂的认识,提高诊断水平是减少误诊的有效方法,正确的治疗方法选择,可以减少并发症的发生。     

延迟性脾破裂16例诊治体会

延迟性脾破裂（DRS）是外伤性脾破裂的一种特殊类型，病情隐匿，易于误诊、漏诊，死亡率高。江都市塘头医院近9年收治了16例延迟性脾破裂病人，体会到提高对该型脾破裂的警惕，密切观察腹部体征，动态复查B超是基层医院减少误诊的重要措施。     

延迟性脾破裂的早期诊断体会

目的探讨延迟性脾破裂的发病机理和临床特点,总结早期诊断经验。方法1995年7月~2004年8月共收治延迟性脾破裂患者17例,其中车祸6例,斗殴4例,坠落伤3例,重物压伤2例,其他伤2例,均为腹部闭合性损伤。采用保守治疗3例,手术治疗14例,行全脾切除术4例,脾脏部分切除术5例,裂口缝合修补术5例。结果17例患者均全部治愈出院,平均住院16.2d,定期门诊随访数月无异常情况发生。结论提高对该病的认识,通过仔细地询问病史、细致地体格检查、密切地观察病情变化以及辅以各种有效的检查手段,完全可以做到早期诊断并早期治疗,取得满意疗效。     

脾包膜下血肿的护理体会

本院1997年1月-2006年12月共收治脾包膜下血肿患者42例,保守治疗31例，经中西医结合治疗痊愈：11例转化为延迟性脾破裂．经手术治疗．其中8例患者因脾包膜下血肿渐增大,切除脾脏。     

Spontaneous splenic rupture in dengue fever with non-fatal outcome in an adult

A 26-year-old male presented with fever for five days and abdominal pain for 24 hours. System examination identified a soft abdomen with diffuse tenderness. CT-abdomen findings were consistent with splenic rupture with intra and peri-splenic hematoma. Laboratory investigations showed a platelet count of 40,000 per mm(3). In due course he developed hypotension and underwent splenectomy. Non-structural protein 1 (NS1) dengue antigen was positive in the admission sample and IgM dengue antibodies were detected in the follow-up sample. Histopathology of the spleen showed normal architecture with no evidence of hyperplasia, cellular infiltrates or haematological malignancy. Splenic rupture is a rare, but potentially fatal complication of dengue fever and severe dengue which should be suspected when a patient presents with abdominal pain and hypotension. Our case highlights the occurrence of splenic rupture in the viremic phase of dengue illness before the development of IgM antibodies.     

Conservative treatment of a spontaneous splenic rupture in a patient with infectious mononucleosis

A 30-year-old man with flu-like symptoms for several weeks presented at the emergency room with pain in the left upper abdomen. There was no history of trauma. The patient had a spontaneous rupture of the spleen due to mononucleosis infectiosa. He was successfully treated with conservative management during a 7-day period of hospitalisation. Spontaneous splenic rupture is a rare but potentially lethal complication of infectious mononucleosis. Alarming symptoms are left upper abdominal pain, worsening during inspiration, and haemodynamic instability. Although splenectomy is the accepted treatment for haemodynamically unstable patients, some patients, may be adequately treated with conservative management. They should be observed during the critical phase and must comply to a period of restricted physical activity after they are discharged from the hospital. There is no consensus about the length or content of this restriction period.     

Painful rib syndrome: a cause of pain complaints that often goes unnoticed

Three patients, 2 women aged 30 and 64 respectively and one man aged 75, with upper abdominal pain (right in the youngest patient and left in the other 2 patients), experienced tenderness over the lowermost ribs, especially at the end of the lowest floating rib. The diagnosis 'painful rib syndrome' was established once other possible conditions had been excluded. Following an explanation of the condition and some advice about posture, the symptoms disappeared. Painful rib syndrome can be a cause of chronic debilitating pain located in the left or right upper quadrant of the abdomen. The pain is movement and posture dependent. The syndrome is often not recognised. No data on the prevalence are available.     

Pathologists' Pay Nears Radiologists'

A 37-year-old woman presented to the emergency department with severe right upper quadrant abdominal pain that had begun 12 hours earlier. The pain was persistent, non- radiating, and associated with nausea and anorexia. She had complained for the past six to 12 months of intermittent palpitation, gradually increasing fatigue and dyspnea on exertion, and intermittent abdominal fullness. She had no history of significant medical problems and took no medications.

The patient appeared anxious, with a blood pressure of 115/78 mm Hg. Pulse was 145 bpm and regular; respirations, 18 per min; temperature, 37°C; and oxygen saturation, 97% by pulse oximetry. Her breathing was labored, but without crackles on auscultation. No jugular venous distention or peripheral edema was noted. Cardiac examination showed only a rapid regular rhythm with normal heart sounds. The abdomen was soft, with diffuse tenderness, most marked in the right upper quadrant, but without rebound tenderness. A complete blood count was normal. The ECG is shown.     

Epiploic appendicitis

A 50-year-old woman presented with sudden onset of localised pain in the right and later the left lower abdomen, without other complaints. Only tenderness in the left lower abdomen was noted at physical examination. The ESR (25 mm/1st hr) and C-reactive protein (25 mg/l) were slightly elevated. The ultrasound (US) revealed a solid ovoid non-compressible hyperechoic mass (diameter 26 mm) at the point of maximum tenderness. The CT scan confirmed the presence of this lesion which appeared to be an infarction of an epiploic appendix with subsequent inflammation, called primary epiploic appendagitis. On conservative therapy the pain resolved in four weeks. The follow-up US and CT showed disappearance of the lesion after 35 days. When epiploic appendagitis is suspected, an US followed by CT is helpful to confirm the diagnosis and to avoid unnecessary treatment with antibiotics or operation.     

Subcapsular liver hematoma,severe complication of pregnancy toxemia. A case report

Subcapsular liver hematoma is a rare and severe complication of pregnancy. This event is already known to have a poor maternal and foetal prognosis. The authors report a case of spontaneous rupture of subcapsular hematoma of the liver in 40 year old multiparous. Confirmation of diagnosis is obtained by abdominal echotomography or TOM. The surgical treatment of this hematoma joints the traumatic surgery of the liver. In every case foetal extraction by cesarean section constitutes the first therapeutic procedure.     

急性闭合性腹部外伤的螺旋CT诊断及其价值

目的：总结急性闭合性腹部外伤的螺旋CT表现,并探讨其应用价值,进一步提高急性腹部外伤的诊断水平.方法：回顾性分析92例急性闭合性腹部外伤患者的螺旋CT表现,其中男性64例,女性28例,年龄为15～78岁,平均36.5岁.结果：急性闭合性腹部外伤主要累及脾、肝、肾、胰等实质器官及胃、肠等空腔器官,其螺旋CT主要表现为包膜下血肿、实质内血肿、撕裂伤、腹腔积血、腹腔游离气体、肠间隙模糊与肠壁增厚.结论：螺旋CT检查对急性闭合性腹部外伤的诊断具有重要价值,可为临床决定手术或保守治疗提供重要依据.     

妇科急症误诊为阑尾炎24例分析

目的 探讨临床妇科急症误诊为阑尾炎的常见原因以及避免其发生的预防对策,以提高医院的诊疗质量.方法 对我院24例误诊为阑尾炎的妇科急腹症患者进行回顾性分析.结果 24例误诊为阑尾炎的病例最终均行剖腹探查术,术中诊断分别为右侧卵巢囊肿并发蒂扭转4例、盆腔炎附件炎10例、右侧输卵管炎3例、右侧卵巢囊状滤泡破裂3例、右侧卵巢黄体破裂2例、右侧输卵管积脓1例、右侧输卵管妊娠破裂1例,明确急腹症腹痛原因后进行急诊手术治疗,并采取相应的预防对策后治愈出院.结论 在临床诊疗过程中,临床医生应该对就诊的患者进行细致的检查,结合其其它病史及影像学资料,做出正确的临床诊断,只有这样,才能够为患者解除病痛.     

颅脑损伤术后继发非手术区迟发性血肿41例的临床分析

目的 探讨急性颅脑损伤术后继发非手术区迟发性血肿的处理及预后。方法 回顾性分析41例急性颅脑损伤术后继发非手术区迟发性血肿的临床资料。结果 本组患者伤后治疗结果良好12例,轻残6例,重残10例,死亡13例。结论 部分颅脑损伤患者可在早期手术后形成非手术区域的迟发性血肿,严重影响患者的预后,只要能及时发现,尽早治疗和处理即可改善预后。