外伤性小肠破裂38例临床分析

目的探讨外伤性小肠破裂的诊断思维程序与治疗原则。方法对我院1999年1月至2007年6月间收治的外伤性小肠破裂38例临床资料进行回顾性分析。结果本组均行手术治疗,包括小肠破裂修补与小肠部分切除吻合术。治愈37例,死亡1例,并发切口感染3例,肺部感染1例,肠粘连梗阻1例。结论早期诊断,及时手术,合理选择术式,彻底冲洗腹腔,放置有效引流物,治疗合并伤及加强术后处理是提高疗效,减少并发症及降低死亡率的重要手段。     

32例腹部闭合性损伤小肠破裂的诊治体会

目的探讨闭合性腹部损伤致小肠破裂的临床诊断和治疗方法。提高治愈率,减少病死率。方法回顾性分析本院2005年1月至2009年10月手术治疗的闭合性外伤性小肠破裂32例的临床资料。结果早期诊断率（入院即明确诊断）75％（24／32）,行单纯肠修补20例。肠部分切除吻合12例,切口感染5例。全组无死亡,均治愈。结论外伤性小肠破裂重视早期诊断,正确的手术方式,术中、术后良好的治疗,可明显提高治愈率,减少小肠破裂术后并发症,促进疾病的康复。     

外伤性小肠破裂的诊断和治疗

目的总结外伤性小肠破裂的诊断和治疗经验，以期提高诊治水平。方法回顾性分析我院2003年1月-2004年12月60例外伤性小肠破裂的诊断和治疗的临床资料。结果本组60例均行手术治疗．其中治愈58例，死亡2例。1例死于MODS，另1例死于术后腹腔内大出血。术后并发症是MODS1例，出血性休克1例，伤口感染4例和不完全粘连性肠梗阻1例。结论早期诊断，正确的术前、术中处理，术后严密观察病情，及时发现和积极处理术后并发症是提高外伤性小肠破裂治愈率和降低死亡率的关键。     

外伤性膈疝23例诊治体会

目的探讨外伤性膈疝的诊断和治疗方法。方法回顾性分析我院1994年1月~2005年6月间收治的外伤性膈疝23例的临床资料。结果本组术前诊断明确者14例,误诊9例;治愈20例,死亡3例。结论临床经验不足是导致外伤性膈疝误诊、漏诊的主要原因。X线和CT检查在膈疝的诊断中有重要的作用;胸腔穿刺抽出胃肠道内容物对于膈疝的诊断有很大的意义,但应在X线监控下进行,以免发生副损伤。外伤性膈疝一经确诊,应立即手术治疗。     

外伤性小肠破裂65例临床分析

目的：探讨外伤性小肠破裂诊断和治疗方法。方法对本院2007年至2013年收治的65例外伤性小肠破裂患者临床资料进行分析。结果治愈63例，其中，切口感染6例，肺部感染4例，早期炎性肠梗阻2例，腹腔感染1例；死亡2例。结论早期诊断非常重要，早期正确诊断和治疗是提高外伤性小肠破裂疗效、降低其死亡率和并发症的关键。     

小儿外伤性小肠破裂48例诊治体会

小儿外伤性小肠破裂是临床常见的腹内脏器损伤,其发病率占空腔脏器损伤的第1位[1],虽然临床诊断并不困难,但临床上延误诊断和处理不当仍时有发生.我院1996年7月至2006年12月共收治小儿外伤性小肠破裂48例,现对其诊断与治疗分析报告如下.     

外伤性脾破裂42例诊治体会

目的总结外伤性脾破裂的诊疗经验。方法对45例外伤性脾破裂的临床资料进行回顾性分析。结果本组无死亡病例。保守治疗2例,手术治疗40例。术后发生并发症4例,其中继发出血1例,为膈面渗血,再次行手术缝扎止血治愈。3例胰尾部胰漏,经腹腔引流、应用广谱抗生素、营养支持治疗,3~4周后胰漏闭合。结论早期诊断是抢救闭合性脾破裂的首要环节,要重视复合伤的诊断和抢救顺序,优先治疗危及生命的损伤。严重脾破裂一旦确诊,应积极手术治疗。     

小儿外伤性小肠破裂的诊治体会

小儿外伤性小肠破裂在临床常见,发病率占腹内空腔脏器损伤的第一位。我院自1996—2006年共收治小儿外伤性小肠破裂48例,现对其诊断与治疗体会报告如下。[第一段]     

非手术治疗外伤性脾破裂

目的 探讨非手术治疗外伤性脾破裂的可行性及适应证.方法 回顾分析1998年以来我院非手术治疗88例外伤性脾破裂的临床资料及其治疗效果.结果 88例均经B超检查确诊脾破裂,Ⅰ级损伤19例,Ⅱ级损伤57例,Ⅲ级损伤12例,其中部分病人合并肋骨骨折,肝肾损伤或颅脑损伤.3例中转手术.结论 有选择的非手术治疗外伤性脾破裂是安全有效的治疗方法,轻度的肝肾损伤、腹腔外器官合并伤及病人的年龄并不影响非手术治疗的疗效.     

外伤性胃穿孔30例诊断和外科治疗

目的 探讨外伤性胃穿孔的临床特点与诊治。方法 回顾性分析30例外伤性胃穿孔患者的临床资料,全部均行手术治疗,其中胃穿孔修补术28例,胃部分切除胃空肠吻合术2例。结果 治愈27例,死亡3例,病死率10％。结论 开放性损伤是外伤性胃穿孔常见的致伤原因,合并伤常见。手术是外伤性胃穿孔的主要治疗手段,以缝合修补为主。术中应注意胃贯穿性与后壁穿孔及其他脏器的合并伤的处理。     

小肠扭转的发病机制及早期诊断探讨（附43例报道）

目的总结成人小肠扭转的病因、发病机制及早期诊断经验。方法对2009年10月至2012年10月期间摩洛哥赛达特省哈桑二世医院收治的43例小肠扭转患者的临床资料进行回顾性分析。结果本组43例小肠扭转患者中自发性小肠扭转11例,继发性小肠扭转32例,术后腹腔粘连为主要继发原因,有19例（59．4％）。临床表现：早期持续剧烈腹痛40例,频繁呕吐29例,肠型或腹部包块28例。43例小肠扭转均手术,其中22例术前B超确诊。术中见肠坏死16例。治愈37例,死亡6例。结论小肠扭转以继发性为主,术后腹腔粘连是小肠扭转的主要原因;小肠扭转与肠梗阻可互为因果;早期小肠扭转具有腹痛剧烈、呕吐早、症状体征不符等特点,早期诊断以临床为主,B超和CT具有辅助诊断价值;该病起病急,进展快,宜早期手术介入。     

闭合性外伤性肠破裂诊断和治疗(43例报告)

目的 探讨闭合性外伤性肠破裂的诊断与治疗。方法 对43倒闭合性外伤性肠破裂进行了回顾性分析。结果本组43例患者通过手术治疗全部治愈。术后并发症是不完全性粘连性肠梗阻1例,肠间脓肿2例,均经非手术治疗痊愈出院。切口感染4例,经切开引流后治愈。结论 早期诊断,正确处理多发伤和休克,选择好手术时机和手术方式是提高疗效的关键。     

外伤性膀胱破裂7例报告

目的：探讨外伤性膀胱破裂的诊治方法。方法：分析外伤性膀胱破裂７例，６例行膀胱灌注试验确诊，１例因尿道断裂行尿道会师术时发现。７例均行膀胱修补术，其中５例行膀胱造瘘术，２例留置导尿管引流。结果：７例均痊愈，术后排尿正常。结论：膀胱灌注试验结合腹腔穿刺检查是膀胱破裂简单而可靠的诊断方法。     

外伤性小肠穿孔的诊断与治疗体会

目的 通过回顾性分析进一步提高外伤性小肠穿孔的诊治水平。方法 回顾性分析我院自1998-2004年外伤性小肠穿孔68例患者的临床资料。结果 68例均行手术治疗，其中漏诊11例，死亡1例，切口感染3例，切口裂开2例，吻合口漏1例。结论 外伤性小肠穿孔一经诊断或高度怀疑时应立即手术探查，术中应全面仔细探查，防止因其他并存疾病而漏诊。早期诊断及及时合理的处理是提高治愈率、减少并发症的关键。     

Internal hernia after pancreas transplantation with enteric drainage: an unusual cause of small bowel obstruction

BACKGROUND: Although complications involving leaking at the enteric anastomosis site, graft thrombosis, and intraabdominal abscess formation have been well documented after pancreas transplantation, the occurrence of small bowel obstruction in this setting has received scant attention. Although uncommon, intestinal obstruction after pancreas transplantation may have atypical etiologies. In this article, we will review three unusual cases of intestinal obstruction in pancreas transplant recipients. The value of computed tomographic (CT) enteroclysis in equivocal situations in the diagnosis of the obstruction is emphasized. METHODS: In this study, we reviewed the posttransplant course of all pancreas transplants performed between July 1, 2002 and June 1, 2004. We specifically focused on all patients that required reexploration for suspected small bowel obstruction at any time after transplantation. RESULTS: A total of 65 pancreas transplants were performed between July 1, 2002 and June 1, 2004. Pancreas graft survival was 97%, and patient survival was 98.5%. Five (7.7%) patients presented with mechanical small bowel obstruction, three of which were secondary to internal herniation of small intestine through a defect posterior to the pancreas allograft. All patients recovered well postsurgically. DISCUSSION: Small bowel obstruction is an uncommon complication after pancreas transplantation. CT enteroclysis in the evaluation of small bowel obstruction may assist the patient care decision-making process by providing information on the location and severity of the obstruction in the clinical situation where conventional abdominal CT and radiography are equivocal. Prompt detection of small bowel obstruction with early surgical intervention can minimize complications and preserve allograft function.     

Small bowel metastases from lung cancer

Lung cancer is usually diagnosed at an advanced stage and metastases are present in 50% of patients. Small bowel metastases from lung cancer are rare, being more frequent in patients with melanoma, uterine, ovarian, kidney or gastrointestinal cancer, or osteosarcoma. From November 1998 to August 2003, 740 cases of lung cancer (641 non-small-cell lung cancer and 99 neuroendocrine tumours) were diagnosed. We also observed 64 patients with malignant pleural mesothelioma and performed 23 pleuropneumonectomies. Over the same period we admitted 4 patients (one recurrent) with small bowel metastases, three from lung cancer and one from malignant mesothelioma. The clinical symptoms were bowel occlusion and intestinal bleeding. Radiological techniques such as small bowel enema and CT enteroclysis were used with positive results. In one patient with intestinal bleeding capsular endoscopy revealed a bleeding metastasis. All patients were operated on. Neither mortality nor morbidity were observed. All patients were discharged after a median stay of 10 days. One patient is still alive and disease-free 39 months after the first intestinal surgery for metastases. Intestinal metastases from lung cancer are rare and the diagnosis is often late. In some cases the clinical manifestations of the metastases are observed before those of the primitive tumour. However, in the presence of small bowel occlusion and intestinal bleeding of uncertain origin, clinical history-taking is very important and diagnostic procedures must be performed to exclude a secondary pathology.     

创伤性膈肌破裂86例诊治体会

目的探讨创伤性膈肌破裂的早期诊断和治疗方法。方法对收治的86例创伤性膈肌破裂患者的临床资料进行回顾性分析。结果 86例创伤性膈肌破裂患者中治愈80例,死亡6例。结论对创伤性膈肌破裂患者必须早期诊断,及时手术。     

Laparoscopic management of traumatic ruptures of the diaphragm

Introduction: As a result of the relatively high frequency of high-speed accidents, diaphragmatic rupture is a diagnosis that is increasingly being established. Not all of these, usually multi-traumatized, patients are diagnosed as having diaphragmatic rupture immediately following the traumatic event – rather, an appreciable number of these injuries are not detected until some time later – often after a considerable delay. Most of the cases involve rupture of the left diaphragm, with most defects occurring in the region of the central tendon. Methods: During the course of the second half of the year 1998, we operated on three patients with left diaphragmatic rupture. Two of these patients were treated immediately following traumatization, while the third case was a 10-year-old rupture originally misdiagnosed as a para-esophageal hernia. In all three cases, we were able to reduce the hernia and close the diaphragmatic defect laparoscopically. In the case of the two patients with a fresh rupture, the post-operative course was unremarkable, while in the patient with the missed rupture, a serous pleural effusion requiring drainage occurred on the left side. Conclusion: Overall, it would appear that in the case of an acute traumatic diaphragmatic rupture in particular, laparoscopic management, with its low level of traumatization and excellent access, offers a favorable alternative to conventional surgery. A point to be considered, however, is the fact that probably not every hospital will have the facilities for laparoscopic management available on a 24-h basis. In the case of long-standing ruptures, reduction of herniated bowel and treatment of the rupture will make considerable demands on the surgeon. Received: 14 June 1999 Accepted: 27 December 1999     

What have we learned about traumatic diaphragmatic hernias in children?

BACKGROUND/PURPOSE: Diaphragmatic injuries have been reported to be a predictor of serious associated injuries in trauma and a marker of severity. The aim of this retrospective study was to identify pitfalls in the diagnosis and treatment of these injuries in children. METHODS: Data were collected from all patients admitted to the trauma service with traumatic diaphragmatic hernias for the period of January 1977 to August 1998. The authors evaluated 15 cases of traumatic diaphragmatic rupture (6 girls and 9 boys). RESULTS: Mean age was 7.5 years (range, 3 weeks to 15 years). Thirteen patients suffered from blunt trauma, and 2 patients suffered from penetrating trauma. The right and left hemidiaphragms were injured equally (7 patients each), with 1 additional patient suffering from bilateral injuries. All but 1 patient had laparotomies for trauma (n = 14). The diagnosis was made preoperatively in 8 patients (53%) with just a chest radiograph. Computed tomography (CT) scan, magnetic resonance imaging (MRI), and oral contrast studies were used as ancillary tests to diagnose traumatic diaphragmatic rupture. There were 3 missed injuries. Associated injuries included liver lacerations (47%), pelvic fractures (47%), major vessels tear (40%), bowel perforations (33%), long bone fractures (20%), renal lacerations (20%), splenic lacerations (13%), and closed head injuries (13%). The mean hospital stay was 20 days (range, 7 to 60 days). Complications were observed most commonly in those patients with multiple injuries and included postoperative ileus (40%), pneumonia (30%), pancreatitis (20%), wound infection (20%), intestinal obstruction (20%), cholestasis (10%), and renal failure (6%). Five deaths (33%) were caused by hemorrhagic shock, respiratory failure, coagulopathy, and refractory acidosis. CONCLUSIONS: Traumatic diaphragmatic hernias usually are associated with serious injuries in children. It is important to combine a high index of suspicion with radiological diagnostic tests in patients at risk. Palpation and/or visualization of both diaphragms at laparotomy is extremely important in detecting these injuries when they are not suspected preoperatively.