外伤性膀胱阴道直肠贯通伤

外伤性膀胱阴道直肠贯通伤经合理的手术可Ⅰ期治愈,并可减少术后并发症,避免再次手术。     

结直肠、膀胱贯通伤的救治探讨

结直肠、膀胱器官虽然相邻,由于所处位置的特殊性,两器官同时损伤的机遇较少。我院从2004～2008年间,共收治结直肠、膀胱贯通伤52例,由于伤道深,探查难,易忽略,感染高,并发症多等特点,给救治工作增加难度。为总结经验,现将我院结直肠、膀胱贯通伤救治情况结合文献报道分析如下。     

巨大阴道结石合并膀胱阴道瘘、直肠阴道瘘1例

患者女,61岁,因肛门坠胀不适2月,大便带血10 d入院.41年前曾因分娩导致膀胱阴道瘘,未治愈;3年前行膀胱造瘘术.42岁绝经.查体:一般情况较好,各项生命体征平稳,腹部平软,肝、脾未扪及,双肾区无明显叩痛;     

腹部贯通伤致输尿管损伤漏诊1例报告

病例　李某 ,男 ,18岁 ,某部战士 ,在演习中不慎被手枪弹击中左下腹 ,子弹从右臀上部穿出。伤后即送往团卫生队行抗休克、留置尿管、剖腹探查术等处理 ;探查术中见小肠及肠系膜多处破裂 ,腹腔内有大量积血及肠内容物 ,总量约 30 0 0m1,清除积血及肠内容物后行小肠修补术、肠系膜修补术放置腹腔引流管两根 ,伤后 3d后因出现呕吐、腹胀、尿量少 ,由团卫生队转送我院普外科 ,经胃肠减压处理后肠梗阻症状缓解 ,同时发现腹腔引流管内引出大量清亮液体约 2 70 0ml/d ,导尿管内引出的尿量少 ,查腹腔引流液中BUNl2 6mmol/L、尿中BUN16 4mmol/L ,…     

膀胱阴道瘘一例

患者　女 ,40岁。 1年前曾因子宫肌瘤行子宫切除术 ,术后 10ｄ余即出现“尿失禁”。 1年来 ,曾在数家医疗机构诊治 ,做Ｂ超检查数次 ,均诊断为“手术后神经源性尿失禁”、“尿路感染” ,经抗感染治疗无效 ,来我院做ＭＲＩ检查。ＭＲＩ检查 :行盆腔轴面Ｔ1ＷＩ、Ｔ2 ＷＩ及轴面Ｔ1Ｗ增强扫描 ,以及冠、矢状面增强前后Ｔ1ＷＩ。平扫时轴面、冠状面成像见膀胱充盈良好 ,矢状面Ｔ1ＷＩ发现膀胱后方有小类圆形低信号影 (图 1) ;静脉注入钆喷替酸葡甲胺 (Ｇｄ ＤＴＰＡ)后行脂肪抑制成像 ,见膀胱内充满高信号的含对比剂的尿液 ,轴面、冠状面成像无…     

经眶脑干、枕叶螺丝刀贯通伤一例

患者　男 ,6岁 ,因被人用螺丝刀由右眶刺入脑内半小时而收入院。体检 :呈深昏迷状 ,潮式呼吸 ,ＧＣＳ 4分。右眼球完整 ,螺丝刀由内眦紧贴眼球内侧插入。 15ｃｍ长螺丝刀杆仅剩 1ｃｍ与刀柄留置在眼眶外 ,刀杆直径 8ｍｍ ,头部宽12～ 15ｍｍ ,顶在枕内粗隆上。右眼球固定 ,瞳孔 5ｍｍ ,直接、间接光反射均消失 ,左侧瞳孔 3ｍｍ ,无光反应。牙关紧闭 ,左侧肢体及右上肢肌张力低 ,刺痛无反应。右下肢肌张力高 ,刺痛呈伸直状。角膜、腹壁、提睾反射消失 ,病理征未引出。Ｘ线片、ＣＴ示螺丝刀经眶由视神经管刺入脑内 ,贯通右侧脑干、枕叶 ,并有…     

直肠膀胱腹腔贯通伤的术中处理体会

总结直肠(阴道)膀胱腹腔贯通伤的诊治经验.认为掌握肛管直肠膀胱腹腔贯通伤的临床特点,做到早期正确诊断,选择合理手术方案,加强围手术期治疗,是提高疗效的关键.     

肛管直肠膀胱后尿道贯通伤的诊治

目的 探讨肛管直肠膀胱后尿道贯通伤的诊断与治疗。方法 回顾性总结1995年－2000年肛管直肠膀胱后尿道贯通伤12例，行肛管直肠膀胱伤口清创缝合，粪便尿液有效转流、充分骶前引流。结果 本组12例均治愈，其中2例术后并发骶前间隙感染，经充分引流而愈；1例肛门括约肌修补失败，行Ⅱ期修补治愈；1例发生直肠膀胱瘘，保守治疗而愈。无肛门狭窄、排尿困难、阳瘘等并发症。结论 掌握肛管直肠膀胱后尿道贯通伤的临床特点，及时作出准确诊断，选择合理的手术方案，加强围手术期治疗，是提高疗效的关键。     

高温钢管致腹部多脏器贯通伤1例

1病例报告 患者男,20岁,在工作时不慎被一长约10m、直径2．5cm烧红的钢管直接击中上腹部,从右腰背部穿出。1h后送入院。查体：血压11／7kPa,心率114／min,神志清楚,急性痛苦病容,被动左侧斜卧位。腹部伤道有内容物及血溢出,全腹压痛,轻度反跳痛,肠鸣音消失,留置导尿为肉眼血尿。即人手术室,建立两条静脉通道,快速补液、输血。在平车上行气管内插管麻醉,消毒留在腹部的断端钢管及伤道,轻轻从腹部拔出钢管,用纱布填塞伤道压迫止血。常规消毒,PVP清洗伤道口。行腹腔探查,见腹腔内大量肠内容物,有恶臭和活动性出血。横结肠右中段贯通、溃烂,十二指肠水平部贯通,后腹膜血肿,右肾肿大淤血,右肾蒂活动性喷血。其伤道、大小肠多处贯通伤均为3度烫伤。第11、12后肋骨粉碎性骨折。     

子宫托致膀胱阴道瘘1例

病例女,66岁,孕2产2,49岁绝经,因子宫脱垂自行放置子宫托2年,自觉尿失禁2个月于2012-05-07就诊入院.入院查体:双肾区及双侧肋脊角对称、无隆起,双肾区无压痛及叩击痛,双侧输尿管走行区无压痛及反跳痛,耻骨上区无压痛.妇科情况:外阴:阴唇萎缩;阴道通畅,淡黄色尿液排出,阴道粘膜薄,散在充血,皱襞消失,阴道前穹窿横向裂伤,与膀胱贯通,尿液自裂伤处排出,可见子宫托部分轮廓,嵌顿紧;宫颈:萎缩不明显,表面充血;子宫:前位,萎缩;双附件区未触及明显异常.入院诊断:(1) 膀胱异物(子宫托);(2)膀胱阴道瘘;(3)子宫Ⅰ度脱垂.入院后给予抗炎对症治疗,并行阴道准备.各项检查结果回报均正常,于05-22在全身麻醉下,行经腹膀胱内异物取出术及膀胱内膀胱阴道瘘修补术及圆韧带悬吊术.术中见:子宫及卵巢明显萎缩,圆韧带松弛,子宫托嵌顿于膀胱内.取出子宫托后,见膀胱后壁接近输尿管开口上方1.5 cm处横向裂伤,与阴道前壁贯通,长约5 cm,裂口周围有致密的瘢痕组织.术后给予抗炎、补液、留置尿管、冲洗膀胱及膀胱运动等对症治疗,术后16 d治愈出院.     

鱼刺穿透阑尾至腹腔1例

报告1例鱼刺穿透阑尾至腹腔的诊治体会,提示应注意全面询问病史和发病情况;术中操作应轻柔仔细,并强调养成良好的用餐习惯。     

3D delineation of prostate, rectum and bladder on MR images

In radiotherapy planning, target volumes and organs at risk delineation are a tedious and time-consuming task. In this paper we address a method to assist the radiologist in this task. We developed a 3D deformable model for prostate segmentation and used a seeded region growing algorithm for bladder and rectum delineation on MR images. Evaluation of the methods is made by comparison of the results to manual delineation in 24 patients. The following parameters were measured: volume ratio (V(R)) (automatic/manual), volume overlap (V(O)) (ratio of the volume of intersection to the volume of union, optimal value=1), and correctly delineated volume (V(C)) (percent ratio of the volume of intersection to the manual defined volume, optimal value=100). For prostate the V(R), V(O) and V(C) were 1.13 (+/-0.1), 0.78 (+/-0.05) and 94.75 (+/-3.3), respectively. For rectum, the V(R), V(O) and V(C) were 0.97 (+/-0.1), 0.78 (+/-0.06) and 86.52 (+/-5), respectively. V(R), V(O) and V(C) were 0.95 (+/-0.03), 0.88 (+/-0.03) and 91.29 (+/-3.1) for bladder, respectively.     

肛管、直肠损伤的诊治

肛管直肠损伤多为钝性损伤 ,且合并全身多发伤 ,病情复杂 ,易被漏诊 ,应提高对本病的认识。     

Penetrating spinal injury inflicted by screwdriver: unusual morphological findings

A 50-year-old female victim died of recurrent pulmonary embolism, 3 months after having received multiple screwdriver stab wounds in the neck and upper spine. Autopsy showed that one stab had penetrated the middle part of the cervical spinal cord and thus caused an incomplete tetraplegia. In the region of the healed spinal cord and the affected meninges, a considerable amount of hair and textile fibres surrounded by foreign body giant cells and elastic fibres of spinal ligament were found, all of which had been carried into the stab canal by the blunt tip of the screwdriver. In addition to the primary clinical findings, this unusual transportation of matter into the depth of the stab canal allowed identification of the murder weapon.     

直肠损伤致肛管闭锁的教训

报道 1例外伤性骨盆骨折、后尿道断裂、直肠破裂 ,先后 2次手术 ,术后 3个月发现直肠完全闭锁。笔者总结 :(1)骨盆骨折的病人应考虑有直肠刺伤的可能 ;(2 )患者住院及出院均应协助、指导定期行扩肛并定期检查     

Penetrating craniocerebral injury caused by bladed weapons: Three homicide cases

Penetrating craniocerebral injuries caused by a bladed weapon are rare events in western countries and often occur in the course of assault. We studied all homicide-related cases of cranial and brain injuries caused by bladed weapons that were seen at the Medicolegal Institute of Marseille over a 5-year period from 2014 to 2019.We found that such injuries are exceptional. The majority occur in the private sphere and are inflicted by men, as they require considerable force. They are rarely isolated but are accompanied by multiple cutting injuries of the thorax and abdomen. Such assaults leave imprints on the bone that can be analyzed using new anthropological techniques.     

宫颈癌后装放疗时膀胱直肠小肠受照剂量探讨

目的 探讨宫颈癌腔内放疗时不同体积的膀胱、直肠与危及器官受照剂量的关系。方法 选取宫颈癌患者共47例,给予剂量点处方剂量600 cGy的高剂量率腔内后装治疗,用剂量体积直方图(DVH)评价标准计划下不同体积的膀胱、直肠和小肠对相应受照剂量的影响。将膀胱按体积大小分成<80 cm³组、80~120 cm³组和>120 cm³组,直肠按体积大小分成>60 cm³ 组和≤60 cm³组,分析其体积与剂量分布的关系。采用方差分析和t检验方法分析D_{1 cm³}、D_{2 cm³}、D_30%和D_50%。结果 与膀胱体积<80 cm³组相比,80~120 cm³组和>120 cm³组的膀胱D_30%、D_50%受照剂量增高(F=5.074、5.088,P<0.05),小肠D_{1 cm³}和D_{2 cm³}值差异无统计学意义(P>0.05);与直肠体积>60 cm³ 组相比,≤60 cm³组的直肠D_{1 cm³}受照剂量减小(t=-2.045,P<0.05)。结论 宫颈癌近距离放疗时,保持膀胱的适当充盈,直肠体积的减少,可使直肠、膀胱和小肠的受照射剂量均相对降低,从而减少放疗的不良反应。     

Penetrating cardiac injury and the significance of chest computed tomography findings

In rare circumstances, hemodynamically stable patients can harbor serious penetrating cardiac injuries. We hypothesized that chest computed tomography (CCT) is potentially useful in evaluation. The records of all patients admitted to our center with wounds to the precordium or who sustained a hemothorax or pneumothorax after penetrating torso injuries over a 48-month period were reviewed. Those having an admission CCT were studied. The potential diagnostic value of hemopericardium (HPC) and pneumopericardium (PPC) on CCT was examined. Most of the 333 patients were male [293 (88.0 %)] with a roughly equal distribution of gunshot [189 (56.8 %)] and stab [144 (43.2 %)] wounds. Mean age was 28.7?±?12.6 years. Thirteen (3.9 %) patients had cardiac injuries that were operatively managed. Eleven (3.3 %) CCT studies demonstrated HPC and/or PPC. Ten of these patients had an injury with one false positive. Retained hemothorax and proximity findings on the three false negative CCT studies led to video-assisted thoracoscopic surgery or subxiphoid exploration with diagnosis of the injury. HPC and/or PPC on CCT had a sensitivity of 76.9 %, specificity of 99.7 %, positive predictive value of 90.9 %, and negative predictive value (NPV) of 99.1 % for cardiac injuries. However, including all findings that changed management, CCT had a sensitivity and NPV of 100 %. CCT is a potentially useful modality for the evaluation of cardiac injuries in high-risk stable patients. The presence of HPC and/or PPC on CCT after penetrating thoracic trauma is highly indicative of a significant cardiac injury.