创伤性心脏迟发性出血23例报告

<正> 我科自1985—2002年收治心脏外伤后迟发性出血的伤员23例,现报告如下。1 临床资料 本组23例,男18例,女5例,年龄20～48岁。炮弹、地雷爆炸致心肌节线伤7例;刀刺伤6例;胸部挤压致心肌     

新生儿肾上腺出血的影像学诊断

探讨新生儿肾上腺出血的影像学特征。材料与方法,男５例,女２例,年龄４小时－１４天。７天以下５例。全部病例均作Ｂ超检查,其中４例在１周后复查。３例同时作ＣＴ检查,１例于８天后复查。结果（１）Ｂ超肾上腺出血７例中,表现为无或低回声团块５例,强弱不均回声团块例。（２）ＣＴ：３例均为右侧肾上腺出血。（３）全部复查病例显示血肿形态,大小,密度均有改变。结论新生儿肾上腺出血诊断主要依据其影这表现。     

胆胰术后迟发性出血介入治疗

【摘要】 目的 探讨胆胰术后迟发性出血介入治疗方法、技术和效果。方法 总结海军军医大学东方肝胆外科医院2016年7月至2019年6月期间采用血管内介入术治疗74例胆胰外科术后迟发性出血患者的经验,对比不同介入治疗方法的效果,分析影响患者死亡的因素。结果 74例患者首次血管造影阳性率为90.5%（67/74）,血管内介入治疗成功率为98.6%（73/74）,死亡率为29.7%（22/74）。死亡主要原因为再出血15例（20.3%）、肝衰竭4例（5.4%）、感染2例（2.7%）、介入操作不成功1例（1.4%）。不同疾病诊断和手术方式间死亡率差异有统计学意义（P＜0.05）,肝门胆管癌患者死亡率较高。出血类型、出血动脉对术后迟发性出血患者死亡率均无明显影响（P＞0.05）。非出血性并发症显著增加患者死亡率（P＜0.001）。再出血患者死亡率显著高于无再出血患者（65.2%对12.0%,P＜0.001）。覆膜支架植入患者死亡率（26.5%）低于栓塞治疗患者（30.8%）,但差异无统计学意义（P＞0.05）。 结论 血管内介入术是治疗胆胰术后迟发性出血的有效方法。需合理选择覆膜支架和栓塞方法。减少术后并发症、降低再出血是控制胆胰术后迟发性出血死亡率的关键。     

自发性肾上腺出血误诊2例

肾上腺出血比较少见，笔者曾自发性肾上腺出血二例误诊为肾上腺肿瘤，为提高本病的诊断水平，结合文献进行总结，报告如下：     

外伤性迟发性脾破裂诊治的探讨

总结36例外伤性迟发性脾破裂的诊治经验。外伤性迟发性脾破裂出血大多发生在受伤后2周内,应严密动态观察生命体征和腹部体征改变。复查B超和CT等有助于早期诊断;治疗以脾切除加自体脾组织网膜内移植术较为合理。     

外伤迟发性食管破裂的诊治

我院１９７３～１９９３年共收治闭合性胸部外伤２３６例，其中３例伤后８～１２天并发液气胸，经碘油造影诊断为食管破裂．临床资料例１，男，５５岁．被牛角撞伤右胸，胸壁瘀血１１ｃｍ×１６ｃｍ．胸片无异常．伤后１２天呕吐致上腹和右胸剧痛，伴咳嗽、气急．胸片示右...     

腹腔镜胆囊切除术后迟发性出血死亡1例

病人,男,57岁.因腹腔镜胆囊切除术后15 d,剧烈腹部疼痛48 h 入院.患者入院前15 d 因"胆囊结石"在外院行"腹腔镜胆囊切除术",术后恢复尚可,偶有上腹部胀痛不适感.入院前2 d 无明显诱因突然出现全腹剧烈疼痛,伴发热(体温未测),无寒战,轻度恶心,无呕吐,无反酸及嗳气,无腹泻及便秘,未予诊治,因症状逐渐加重而急诊来院.术后患者一般状况欠佳,入院前2 d 未进食,二便无明显异常.     

超声诊断新生儿肾上腺出血2例

1　病历简介例1　男,3天。因黄疸贫血入院。查体心肺听诊未发现异常,腹部可触及可浮性肿物,患儿一般状态差,反应低下。超声检查所见:左右侧肾上腺区域分别可见52ｃｍ×36ｃｍ,15ｃｍ×10ｃｍ无回声区,边界欠规整,形态近似椭圆形。患儿38天复查右侧原病灶消失;左侧病灶缩小仍可见21ｃｍ×20ｃｍ无回声区,其内可见散在强回声光点,边界不规整。3个月后复查左侧亦恢复正常。例2　　男,7天。足月自然分娩,羊水清,无脐带绕颈,生后窒息1ｍｉｎ,以周身黄染拒乳伴抽搐为主入院。超声检查所见:右肾上腺区域可见43ｃｍ×31ｃｍ无回声团块,呈椭圆形,边界…     

超声诊断胸部外伤后迟发性创伤性二尖瓣关闭不全1例

患者，男，41岁，因胸闷、气短、活动后加重入院。查体发现患者颈静脉怒张，心界向左下扩大，心前区可闻及Ⅳ级收缩期杂音，双肺底部均闻及细湿罗音，肝、脾增大，双下肢凹陷性水肿。     

肾综合征出血热患者垂体和肾上腺出血坏死

兹将本校收治西安地区肾综合征出血热(HFRS)24例患者死亡后尸解结果,着重于垂体和肾上腺组织的病理变化予以报道,提供对本病幸存者今后防治和随访时参考。 HFRS患者24例,男20例,女4例。年龄16～60岁。从HFRS发病之日至死亡之日止,病期4～45天,平均12.3±9天。治疗措施:60年代用葡萄糖、生理盐水输注,去甲肾上腺素静脉滴注;70年代用阿托品静脉滴注;80年代用平衡盐、低分子右旋糖酐、环磷酰胺以及各种止血药如6-氨基己酸、止血芳酸、止血敏、维生素K、白药、氢溴酸山莨菪碱等治疗。1例于发热休克期应用去氢氢化考的松,40mg/d,共10天;另1例于休克期应用氢化考的松,     

Delayed posttraumatic adrenal hematoma

Posttraumatic adrenal hemorrhage is a frequent finding after severe abdominal trauma and can have important clinical implications if it is bilateral. With the increased use of helical CT in the evaluation of trauma patients, posttraumatic adrenal hematoma is more frequently diagnosed. We present the CT findings of a unilateral posttraumatic adrenal hemorrhage where the diagnostic findings only appeared in the follow-up study. We think that mild enlargement of the adrenal gland in a trauma patient can be an early sign of an impending adrenal hemorrhage. Received: 10 May 1999; Revised: 28 July 1999; Accepted: 18 August 1999     

Delayed epidural hematoma after evacuation of a subdural hematoma

CT easily diagnoses epidural hematomas. The appearance of an epidural hematoma may be delayed by compression from a contralateral lesion. The possibility of a delayed epidural hematoma should be kept in mind in the presence of additional findings such as a skull fracture contralateral to the original lesion or decompression of the epidural hematoma into either the subgaleal or the subarachnoid space. We present a case in which an epidural hematoma declared itself after the evacuation of a contralateral subdural hematoma.     

Right adrenal hematoma following hepatectomy

We present the findings and possible causes in three cases of postoperative adrenal hematomas. In 16 cases of 45 consecutive patients, following segmental right or left lobe hepatectomy, CT was performed in order to evaluate possible fluid collection or other complications. In all cases imaging findings and a correlation with preoperative CT scans were done. Follow-up CT examinations were also reviewed. In three cases solid suprarenal masses with attenuation values consistent with adrenal hematomas were found. Preoperative scans at the same level indicated normal adrenal glands. Follow-up scans revealed the hematoma, stable in size, for up to 12 weeks, although lower attenuation values were evident. Right adrenal hematoma is a possible postoperative complication following hepatectomy; if it remains stable in size, it can be left alone. Received: 29 December 1998; Revised: 25 March 1999; Accepted: 18 May 1999     

CT manifestations of adrenal trauma: experience with 73 cases

Adrenal injuries, although an uncommon consequence of abdominal trauma, are important to recognize. If bilateral, adrenal trauma could result in life-threatening adrenal insufficiency. Furthermore, in the setting of trauma, adrenal injury can point to other concomitant injuries and has been associated with overall increased morbidity and mortality. In the past, before the advent of computed tomography (CT), detection was difficult, and the diagnosis was often made only at surgery or postmortem. Today, the diagnosis of adrenal injuries can be quickly and accurately made with CT. This retrospective review was carried out to identify, describe, and analyze different CT appearances of adrenal injuries and correlated with associated injuries and observed clinical context and outcomes. A patient cohort of CT-detected adrenal injuries was identified through a radiology software research tool by searching for keywords in radiology reports. The identified CT scans were reviewed and correlated with the patients’ available clinical chart data and follow-up. Between April 1995 and October 2004, 73 cases of CT-detected adrenal injuries were identified, including 48 men and 25 women, with an age range 6 to 90 years and a mean age of 42.7 years. Of the cases, 77% were right-sided, 15% were left-sided, and 8% were bilateral. The causes of injuries were motor vehicle collisions (75%), falls (14%), sports related (4%), and miscellaneous causes (7%). Associated trauma included injuries of the liver (43%), spleen (23%), lung (19%), and kidney (18%), as well as pneumothoraces/hemothoraces (22%). Skeletal injuries included fractures of the ribs, clavicles, and/or scapulae (39%), pelvis and hips (30%), and the spine (23%). Isolated adrenal trauma was seen in only 4% of the cases. The CT findings of adrenal trauma were focal hematoma (30%), indistinct (27%) or enlarged (18%) adrenal gland, gross (15%) or focal (7%) adrenal hemorrhage, and adrenal mass (11%). Associated CT findings included periadrenal fat stranding (93%), retroperitoneal hemorrhage (22%), and thickened diaphragmatic crura (10%). Active adrenal bleeding was seen in one case (1.4%). The incidence of adrenal trauma was estimated to be 0.86%. Surgical management was required only for the associated injuries. The most common CT manifestations of adrenal trauma include focal hematoma, indistinct or ill-defined adrenal gland, adrenal enlargement or mass, and gross or focal adrenal hemorrhage in a normal-sized gland. Periadrenal stranding is very common. Retroperitoneal hemorrhage and crural thickening are also important associated findings. Operative intervention is typically required only for the associated injuries, which commonly accompany adrenal trauma. This original research article was presented at RSNA 2005.     

Delayed epidural hematoma

Summary A case of delayed epidural hematoma is described who had an initial computerized tomography (CT) scan reported as normal. Repeat CT scan at 48 h demonstrated a right temporal epidural hematoma. A skull fracture was not observed radiographically or at surgery. The world literature is reviewed and the criteria for repeat CT scanning is discussed.     

外伤性迟发性颅内血肿

对62例迟发性颅内血肿患者进行CT监测,认为迟发性颅内血肿在CT的监测下,能够及时发现。根据病情变化及时手术是治疗此病的关键措施。     

CT动态增强鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值

目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。     

小儿外伤性迟发性脑内血肿

目的 探讨小儿外伤性迟发性脑内血肿的临床特点，诊断和治疗。方法 回顾性分析我院1987年1月-1998年12月收治的27例小儿外伤性迟发性脑内血肿。结果 27例小儿外伤性迟发性脑内血肿中，行血肿清除术13例，颅骨钻孔血肿内置管 增强尿激酶外引流术6例，非手术治疗8例，26例治愈，1例死亡，死亡率3.70%。结论 进行性意识障碍，头痛，呕吐，贫血加重和生命体征不稳定是小儿迟发性脑内血肿的基本临床特征，高度警惕本病的发生，及时再次CF扫描有利于早期诊断，掌握好手术和非手术治疗的指征，是治愈本病的关键。     

ICI174,864抗大鼠创伤失血性休克作用与肾上腺髓质的关系

目的　探讨δ阿片受体特异性拮抗剂ICI174 ,86 4对创伤失血性休克大鼠血流动力学指标的影响及其与肾上腺髓质的关系。方法　复制大鼠创伤失血性休克模型 ,观察侧脑室给ICI174 ,86 4后对血压(MAP) ,左室内压 (LVSP) ,左室内压最大变化速率 (±dp/dtmax)等血流动力学指标的影响及摘除肾上腺髓质对ICI174 ,86 4作用的影响。结果　ICI174 ,86 4 (5 0 μg,2 0 μl)侧脑室给药可显著改善创伤失血性休克大鼠的MAP、LVSP、±dp/dtmax等血流动力学指标。摘除肾上腺髓质可使ICI174 ,86 4的上述作用消失。结论　δ阿片受体特异性拮抗剂ICI174 ,86 4对创伤失血性休克心血管功能指标有较好的改善作用 ,ICI174 ,86 4的这一作用与肾上腺髓质密切相关 ,有赖于肾上腺髓质的完整性。提示ICI174 ,86 4的抗休克作用可能与肾上腺髓质分泌的儿茶酚胺有关。     

Magnetic resonance imaging of adrenal cortical carcinoma

Five cases of adrenal cortical carcinoma examined with magnetic resonance (MR) are presented. Clinical histories, computed tomographic (CT) scans, and final pathologic findings were reviewed in each case. All masses were hypointense compared to the liver on T1-weighted images and became hyperintense compared to the liver on T2-weighted images. Signal intensity of adrenal masses, fat, and liver were measured. Adrenal/liver and adrenal/fat signal intensity ratios were then calculated. All the masses were readily identified with MR. The MR also demonstrated displacement or invasion of adjacent organs, as well as liver metastases. The inferior vena cava was also identified in each case. Even though there were no consistent MR findings to diagnose adrenal cortical carcinomas accurately, superior blood vessel identification and multiplanar capabilities may make MR the imaging modality of choice in evaluating the extent of disease and in planning surgical excision.