严重多发脏器损伤的临床特点及诊治

目的探讨严重多发脏器损伤的临床特点和诊治方法.方法对1988～1998年间收治的合并有闭合性腹内脏器损伤的严重多发伤、ISS大于16的165例患者进行回顾性分析.结果3个或3个以上部位多发伤占28.5%.63例有腹内多脏器损伤.腹腔穿刺是确诊的主要检查手段,部分病例选用了腹部B超和CT,3项诊断检查阳性率均在90%以上.全组漏诊腹内伤21例(12.7%),死亡29例(17.6%).死亡病例平均ISS41.6,明显高于非死亡病例24.8(t=15.21,P<0.01).结论严重多发伤病例应常规行诊断性腹腔穿刺,酌情选择腹部B超和CT等检查,以排除腹内脏器损伤.对全身多发伤并存腹内伤的病例,要根据伤情确定急救处理顺序.剖腹手术中要注意多脏器损伤.ISS大于40提示预后不良.     

外伤性小肠破裂的诊治

目的探讨外伤性小肠破裂的早期诊断及治疗方法。方法对288例外伤性小肠破裂病人的临床资料进行回顾性分析。结果典型腹膜炎表现者209例（72．6％）;腹腔穿刺198例,阳性175例（88．4％）;腹腔灌洗28例,阳性22例（78．6％）;B型超声检查214例,阳性177例（82．7％）;288例KUB平片,发现膈下游离气体143例（49．7％）;CT检查65例,阳性43例（66．2％）。治愈280例（97．2％）,死亡8例。结论重视外伤性小肠破裂常见症状和体征,积极应用各种腹腔穿刺技术,并结合血常规、X线、B型超声、CT等辅助检查,早期诊断,避免漏诊误诊,尽早手术探查,选择合理术式可明显提高治愈率及病人生活质量。     

腹腔镜探查术与剖腹探查术在腹部外伤合并胃肠道损伤中的应用效果对比

目的对比腹腔探查术与剖腹探查术对腹部外伤合并胃肠道损伤患者术后恢复及并发症的影响。 方法选取2010年9月到2015年9月收治的158例腹部外伤合并胃肠道损伤患者作为研究对象,92例采用腹腔镜探查术为观察组,66例采用剖腹探查术为对照组,观察两组患者的手术时间、术中出血量、术后排气时间以及胃肠功能恢复时间等差异,并比较两组的术后疼痛程度以及并发症。 结果观察组患者手术的切口长度以及术中的出血量都明显小于对照组,手术时间、术后排气时间、首次下床活动时间、住院时间以及胃肠功能恢复时间较对照组有明显缩短,差异有统计学意义（P<0.05）;观察组患者术后12、24、48 h视觉模糊评分（VAS）分数、并发症及术后镇痛药物使用率显著低于对照组（t=14.301、9.841、18.927,χ²=5.257,均P<0.05）。随访3个月,观察组发生并发症明显少于对照组,两组比较差异有统计学意义（χ²=4.119,P=0.042）。 结论腹腔镜探查术诊治腹部外伤合并胃肠道损伤病例具有手术创伤小、术后恢复快、疼痛程度低及并发症少等特点,是一种值得进行广泛临床推广的诊治手段。     

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目的 探讨胰腺损伤的诊断和治疗方法。方法 回顾性分析1983～2002年收治的65例胰腺损伤的临床资料。结果 胰腺损伤Ⅰ级7例，Ⅱ级24例，Ⅲ级19例，Ⅳ级10例，Ⅴ级5例。单纯胰腺损伤13例(20．0％)，合并其他器官损伤52例(80．0％)。术前诊断为胰腺损伤的仅12例(18．5％)。65例均行手术治疗，治愈56例(86．2％)，死亡9例(13．8％)。结论 胰腺损伤早期诊断困难，应高度警惕。对怀疑或诊断为胰腺损伤者，应尽早手术探查，并根据损伤的部位及严重程度，选择合理的手术方式。     

闭合性胰腺及十二指肠损伤七例诊治体会

目的探讨胰腺十二指肠复合伤的诊断和治疗。方法回顾性分析本院1998年1月～2008年12月收治的胰腺十二指肠联合伤7例的临床资料。结果本组抢救成功5例,术后因休克不能纠正而死亡2例。术后并发十二指肠漏1例。结论及早行手术探查修复损伤和有效的引流是抢救成功的关键。     

腹腔镜诊断和治疗腹部闭合性损伤120例报告

目的:探讨应用腹腔镜诊断和治疗腹部闭合性损伤的临床效果。方法:120例腹部闭合性损伤患者在腹腔镜下诊断和治疗。结果:120例均于腹腔镜下明确诊断并治疗。其中48例出血停止,56例腹腔镜下止血成功,16例腹腔镜下行脾脏切除术。90例避免了剖腹手术,占75%。结论:腹腔镜可用于腹部闭合性损伤的诊断和治疗,且较腹腔穿刺、腹腔灌洗及剖腹探查简便易行。     

胰腺损伤术后早期胃肠外营养支持治疗体会

目的　探讨胰腺损伤术后早期胃肠外营养支持的作用。方法　回顾性分析我们近 6年来收治的 1 5例胰腺损伤术后病人进行早期胃肠外营养支持 (PN)的临床资料。结果　治愈 1 4例 ,发生并发症 2例次。腹腔液淀粉酶显著下降 ,肝、肾功能好转 ,血糖渐趋正常 ,血清白蛋白、转铁蛋白、前白蛋白均明显提高。结论　胰腺损伤术后胃肠外营养支持有利于促进创伤愈合 ,减少并发症的发生     

Diagnosis and management of bladder injury by trauma surgeons

BACKGROUND: Bladder injuries constitute one of the most common urological injuries involving the lower urinary tract. The methods of diagnosis and management of bladder trauma have been well established and accepted. However, bladder injuries are usually associated with other major injuries, and it is our concern here how bladder injuries have been managed as part of multiple trauma. METHODS: From 1991 to 2000, a total of 51 cases of bladder injury were retrospectively reviewed. The mechanisms of trauma, types of bladder injury, time needed to diagnosis, methods of treatment, and patient outcome, were analyzed. Diagnosis time was defined as the time interval from patient arrival to the establishment of a diagnosis either by image studies or laparotomy. Management followed the general rule that bladder contusions or extraperitoneal ruptures were treated non-operatively, and that those with intraperitoneal rupture or combined rupture underwent operative repair. If bladder injury was noted after the patient left the emergency room (ER), it was defined as a delay diagnosis. The Injury Severity Score (ISS), length of hospital stay, and morbidity were used to evaluate patient outcome. RESULTS: The mean age of all the patients was 31.4 years old, and most of them had sustained an injury from a motor vehicle accident (40 of 51). All but 3 patients had gross hematuria. Ten of the patients underwent emergency laparotomy, and 2 of them underwent emergency neurosurgical procedures, therefore no image studies were performed for these 12 patients. A total of 33 patients underwent abdominal computed tomography (CT), but only 20 were correctly diagnosed, yielding an accuracy rate of 60.6%. There were 3 delay diagnoses, due to either a lack of gross hematuria on presentation or the patient leaving the ER before any bladder injury study could be performed. A retrograde cystogram was performed in 24 patients, with an accuracy rate of 95.9% (23 of 24). The mean diagnosis time of the 48 bladder injuries presented in the ER was 3.2 hours and the time needed to reach a diagnosis was not related to the severity of bladder injury. Those patients who underwent operation immediately did not seem to have a quicker diagnosis. Those patients with a higher injury score (ISS >16), and those patients who suffered from pelvic fracture, stayed in the hospital longer. However, the severity of the bladder injury was not related to the length of hospital stay. There was no bladder-related mortality in our series. CONCLUSIONS: We report our results of dealing with bladder injuries from the point of view of trauma surgeons who treat bladder injury as part of multiple injuries. Although known as a procedure of choice for diagnosis of bladder injury, the retrograde cystogram was performed in fewer than half of the patients (24 of 51), which means it is not feasible in many situations. The patient outcome was determined by the severity of injury of the patient but not by the severity of bladder injury.     

胰腺损伤23例诊治体会

目的探讨胰腺损伤的诊断和手术治疗方法。方法回顾性分析我院自1997年1月至2007年12月间收治的23例胰腺损伤的临床资料。结果本组均行手术治疗,治愈21例,死亡2例。其中,死于创伤性失血性休克1例,死于多器官功能衰竭1例。结论胰腺损伤早期诊断困难,腹腔穿刺检查和CT扫描非常重要。关键是保持高度警惕,综合分析判断。对高度怀疑或诊断为胰腺损伤者,应尽早手术探查,按损伤部位及严重程度,选择合理的手术方式,以提高治愈率,减少并发症的发生。     

Evaluating clinical abdominal scoring system in predicting the necessity of laparotomy in blunt abdominal trauma

Objectives

Trauma is among the leading causes of death. Medical management of blunt abdominal trauma (BAT) relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients' signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system (CASS), a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not.

Methods

Totally 400 patients suspected of BAT that arrived at the emergency department of two university hospitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale (GCS), pulse rate, time of presentation after trauma, abdominal clinical findings, respiratory rate, temperature, hemoglobin (Hb) concentration, focused abdominal sonography in trauma (FAST) and CASS.

Results

Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presentation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy (P<0.05).

Conclusion

CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accuracy of diagnosis.     

十二指肠损伤的诊断及治疗

目的提高十二指肠损伤早期确诊率。方法报道１６例十二指肠损伤的诊治体会及５例Ｃｏｇｂｉｌ改良憩室化手术再简化的手术治疗经验。结果十二指肠损伤的早期诊断和及时手术治疗是非常重要的。结论Ｃｏｇｂｉｌ改良手术再简化手术是治疗十二指肠损伤的一种操作简单,远期并发症少的术式     

胰腺损伤的诊断与手术治疗(附25例报告)

目的探讨胰腺损伤早期诊断和合理外科治疗方法。方法回顾性分析我院1995年8月至2008年12月收治胰腺损伤25例的临床资料。结果本组25例,死亡2例。术后发生胰漏11例,十二指肠漏1例。结论早期诊断和及时合理手术是降低胰腺损伤术后并发症发生率和死亡率的关键。     

腹部创伤的诊断与治疗

腹部创伤患者救治中如何降低漏诊率和阴性探查率仍然是临床难题.本文基于血流动力学和致伤机制提出诊断与治疗流程,进一步阐述该流程中涉及的体格检查、创伤重点超声评估（FAST）、CT检查和诊断性腹腔灌洗（DPL）等腹部创伤伤情评估技术,钝性伤和穿透伤手术指征等紧急救治策略,以及腹腔镜下和剖腹时的探查技术.     

儿童腹部闭合伤的诊断与治疗

目的　探讨儿童腹部闭合伤的保守治疗及手术探查的指征和时机。 方法　 将我院１９９０ 年１ 月至１９９８ 年１０ 年住院的２１６ 例腹部闭合伤患儿分为肝脏损伤、脾脏损伤、肾脏损伤、胃肠道损伤、胰腺损伤、输尿管损伤、膀胱损伤,并逐一对其进行回顾性分析。 结果　６５ 例肝损伤,６ 例行剖腹探查;５４ 例脾损伤,８ 例手术,１ 例行脾切除,脾保留９８ ％ （ 未包括２ 例巨脾外伤行脾切除的患儿） ;１８ 例胃肠道损伤,１３ 例手术探查（ 其中５ 例住院后立即手术,８ 例住院２４ 小时后手术） ;６ 例输尿管损伤,均在伤后６ ～２０ 天手术;４ 例膀胱损伤均急诊手术修补;１２ 例胰腺损伤,２ 例手术治疗,１０ 例保守治疗,保守治疗患儿中４ 例伤后４ 周出现假性胰腺囊肿。 结论　（１） 肝损伤保守治疗有一定危险性,输液后,输血超过４０ ｍｌ／ｋｇ ,患儿血压仍不能稳定在正常范围内或出现胆汁性腹膜炎的患儿应手术探查。转氨酶的变化对判断肝损伤严重程度非常有用。（２） 脾损伤患儿输液后输血超过４０ ｍｌ／ｋｇ血压仍不能维持在正常范围内,或巨脾出现脾损伤患儿应手术探查,并应切除巨脾。（３） 胃肠道损伤合并气腹或腹膜炎表现持续加重尤其早期患儿体温明显增高时应手术探查。（     

Management of pancreatic trauma

BACKGROUND: Pancreatic injury can pose a formidable challenge to the surgeon, and failure to manage it correctly may have devastating consequences for the patient. Management options for pancreatic trauma are reviewed and technical issues highlighted. METHOD: The English-language literature on pancreatic trauma from 1970 to 2006 was reviewed. RESULTS AND CONCLUSIONS: Most pancreatic injuries are minor and can be treated by external drainage. Injuries involving the body, neck and tail of the pancreas, and with suspicion or direct evidence of pancreatic duct disruption, require distal pancreatectomy. Similar injuries affecting the head of the pancreas are best managed by simple external drainage, even if there is suspected pancreatic duct injury. Pancreaticoduodenectomy should be reserved for extensive injuries to the head of the pancreas, and should be practised as part of damage control. Most complications should initially be treated by a combination of nutrition, percutaneous drainage and endoscopic stenting.     

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目的　探讨胰腺囊性肿瘤的诊断和治疗。方法　对 1978年以来 19例胰腺囊性肿瘤的临床资料进行回顾性分析。结果　肿瘤位于胰头部 4例 ,胰体尾部 15例。行不同术式的肿瘤切除 13例 ,外引流 1例 ,内引流 2例 ,剖腹探查、肿瘤活检 3例。无手术死亡。随访囊腺瘤 3例 ,分别随访 6个月、16年和 2 1年仍生存 ;囊腺癌 9例 ,生存时间 <6个月 3例 ,6个月至 2年 4例 ,3年 4个月 1例 ,最长 1例 8年仍生存。结论　B超和CT是诊断胰腺囊性肿瘤的有效方法 ,二者结合使用可提高诊断率。该病切除率高 ,预后较好。应首选手术治疗。     

胰腺损伤的诊断与治疗

病史、临床表现和影像学检查是早期诊断胰腺损伤的主要方法,血清淀粉酶检测在胰腺损伤诊断中作用不确定.不能忽视剖腹探查在诊断胰腺损伤的作用,尤其是急诊行剖腹探查的创伤患者.胰腺损伤的分级在其诊断与治疗间起着桥梁作用.目前使用最广泛的是美国创伤外科学会-器官损伤分级（AAST-OIS）.手术治疗是治疗胰腺损伤的重要方法,应遵循损伤控制和分级手术的原则.近年来,微创外科技术在胰腺损伤的诊断与治疗中发挥了一定作用.     

闭合性肾损伤的诊断与治疗

目的 总结闭合性肾损伤的诊治体会，提高闭合性肾损伤的诊治水平，减少肾切除率。方法 189例闭合性肾损伤患者，男146例，女43例。平均年龄38岁。综合应用尿常规、B超、IVU、CT等检查，诊断闭合性肾损伤，其中合并腹腔内脏器损伤27例，合并颅脑外伤5例，合并四肢脊柱骨折13例，3例为腹腔、颅脑与腹腔、脊柱复合伤伴休克。行保守治疗156例，其中有脾破裂3例，颅脑外伤2例，四肢脊柱骨折7例；行手术治疗27例，其中行肾修补术15例，肾部分切除术5例，肾切除7例；3例行肾动脉栓塞治疗。结果3例重度闭合性肾损伤因复合伤、顽固性休克者入院不久死亡，186例痊愈出院。102例随访3个月～8年，保守治疗病例中发生肾性高血压3例，肾周尿囊肿1例，肾萎缩1例，局限性肾积水1例，手术治疗与肾动脉栓塞治疗者均无并发症。结论 CT检查是闭合性肾损伤准确诊断与选择治疗方案的重要依据，Ⅲ级以上闭合性肾损伤伤后2～4周复查CT有利于肾周尿囊肿的早期发现与治疗，Ⅳ级以下闭合性肾损伤尽可能采用非手术治疗。     

胰腺损伤的诊断与治疗

目的:探讨胰腺损伤的诊断与治疗的方法.方法:分析1988年1月至2003年12月间收治的29例胰腺损伤的诊断与治疗情况.按美国创伤外科学会(AAST)胰腺损伤分级:Ⅰ级6例,Ⅱ级4例,Ⅲ级13例,Ⅳ级3例和Ⅴ级3例.27例病人经过外科手术治疗.8例胰腺损伤的病人行局部引流.胰头侧断端胰管结扎闭锁缝合、胰体尾部切除术9例(其中经内镜鼻胰管引流术3例;同时因脾脏严重损伤行脾切除5例).胰头侧断端胰管结扎闭锁缝合、体部断端胰空肠Roux-Y吻合术7例.Ⅴ级损伤3例,十二指肠憩室化术2例;行急诊胰十二指肠切除术1例.结果:23例治愈.1例发生创伤性胰腺炎经保守治疗恢复正常;2例发生胰漏,经引流、善宁治疗治愈;2例形成胰腺假性囊肿,3个月后行胰腺假性囊肿空肠Roux-Y吻合术.1例死于颅脑损伤.结论:胰腺损伤早期诊断是治疗的关键.术中细致探查十分重要.若病情允许,内镜不但有助于胰腺损伤的诊断,而且是治疗胰腺损伤的一种有效方法.依据胰腺损伤类型选择合理的治疗方法,可以减少术后并发症的发生.     

胰腺损伤的诊断和治疗探讨

目的探讨胰腺损伤的诊断和治疗方法。方法对我院自1994年3月至2004年3月收治的24例胰腺损伤进行回顾性分析。结果本组24例中治愈22例,死亡2例。术后有17例发生并发症(58.3%),其中胰瘘11例,胰腺假性囊肿2例,反复发作慢性胰腺炎1例和切口感染3例。结论根据受伤部位、腹痛、呕吐等临床症状和腹部压痛反跳痛等腹膜炎体征应考虑胰腺损伤。淀粉酶检测和影像学检查有助于诊断,手术力求简单有效。