腹部实质脏器损伤的治疗进展

腹部实质脏器损伤的经典治疗原则是剖腹探查,并行确定性的一期手术。随着基础和临床研究的进展,一方面,针对肝、脾、胰的低级别损伤采取非手术治疗已广泛用于临床;另一方面,针对腹部实质脏器严重创伤采取损伤控制性手术受到了应有的重视。一、腹部实质脏器损伤的非手术治疗1.准     

非手术治疗腹部闭合性损伤脾破裂

目的探讨腹部闭合性损伤脾破裂的非手术治疗的适应证及经验。方法对1996年2月一2003年6月采用非手术治疗的37例腹部闭合性损伤脾破裂的临床资料进行回顾性分析。结果37例均痊愈出院。其中非手术治疗成功34例(91．9％)，住院时间为12-23d；另3例因在非手术治疗期间由于延迟性出血引起血液动力学不稳定而中转手术治愈。结论腹部闭合性损伤脾破裂选择性进行非手术治疗是可行的，但必须严格掌握适应证和严密监测伤情的变化如在非手术治疗期间血液动力学不稳定或发生延迟性出血者应及时进行手术治疗。     

腹部实质脏器损伤非手术治疗的进展

腹部实质脏器损伤的经典治疗原则是剖腹探查 ,及时的手术探查救治了不少腹部实质脏器损伤患者的生命 ,但也有不少本不需手术的患者遭受了剖腹手术的痛苦。随着基础和临床研究的进展 ,非手术治疗腹部实质脏器损伤已广泛用于临床 ,甚至超过了手术治疗。1　肝脾损伤的非手术治疗1 .1　历史回顾全脾切除术治疗脾损伤已有近 2 0 0年的历史 ,而且效果较好 ,使脾损伤的死亡率由 90 %～ 1 0 0 %降低到 5 %左右。 1 952年Ｋｉｎｇ等首次报道了儿童脾切除术后发生爆发性感染 ,引起普遍的关注。随着脾脏功能的深入研究 ,人们认识到脾脏虽非生命必需器官…     

超声造影对腹部脏器闭合性损伤的诊断作用研究

目的 探讨分析超声造影检查对腹部脏器闭合性损伤的临床诊断价值。方法 回顾性分析2020年6月至2022年6月本院收治的腹部实质脏器闭合性损伤患者共58例，所有患者均行常规超声检查、超声造影检查以及手术治疗，超声检查结果以手术探查结果作为评估准确率的最终标准。记录并比较常规超声和超声造影检查的敏感性、诊断率和特异性等情况。结果 58例患者中，腹部实质脏器闭合性损伤患者中共53例，手术探查发现，肝损伤者18例，脾损伤者25例，肾损伤9例。与手术探查结果进行比较，超声造影检查的灵敏度为96.23%，特异性为80.0%，准确率为94.83%，阳性预测值为98.08%，阴性预测值为66.67%，常规超声检查的灵敏度为75.47%，特异度为60.0%，准确率为74.14%，阳性预测值为95.24%，阴性预测值为18.75%；超声造影检查的灵敏度、特异度、准确率、阴性预测值均明显高于常规超声检查（P<0.05）。结论 采用超声造影检查腹腔实质器官闭合性损伤时，其具有更高的诊断准确度、敏感度及特异度，且检查简单方便，操作时间短，可迅速实时评估腹部损伤情况，有助于缩短临床救治时间，适合临床选择应用...     

腹部闭合性损伤124例诊治体会

目的 总结腹部闭合性损伤的诊治体会。方法 回顾性分析近5年来收治的124例腹部闭合伤。其中，单一脏器损伤76例，腹部多脏器损伤48例，合并其它重要系统损伤54例。结果 非手术治疗9例（包括介入脾动脉栓塞4例），手术治疗115例。治愈116例，死亡8例。结论 腹部闭合伤病情复杂，发展快，迅速准确诊断，合理的治疗是关键。详细了解病史，结合腹腔穿刺，X线，B超，CT检查可提高诊断率。     

闭合性腹部外伤脾破裂的非手术治疗

目的 探讨闭合性腹部外伤脾破裂非手术治疗病例的临床特点、适应证及治疗方法。方法 对13例非手术治疗组和33例手术治疗组进行回顾性对比分析。结果 采用非手术治疗的13例中,2例中转手术。结论 正确选择脾破裂病例进行非手术治疗是成功的关键。对临床体征较轻、腹腔内出血量少、脾裂伤深度<1cm、CT分级为Ⅰ～Ⅱ级的表浅性较局限的脾挫裂伤或合并包膜下血肿者,可在严密观察下行非手术治疗,如出现明显的活动性出血或不能排除腹内其它脏器损伤者则应及时中转手术。     

腹部闭合性多脏器损伤的围手术期处理

总结腹部闭合性多脏器损伤的围手术期处理经验。１９８５年６月－１９９７年６月，共收治腹部闭合性损伤患者计５２３例，其中腹部闭合性多脏器损伤者７２例，全部行手术治疗证实。     

闭合性肝损伤的治疗228例报道

目的总结闭合性肝损伤手术治疗的经验体会，进一步提高闭合性肝损伤的临床诊断和治疗抉择的水平。方法回顾性分析我院10年内228例闭合性肝损伤患者的诊治资料，调查分析了闭合性肝损伤的损伤程度和临床治疗方案抉择的关系。结果本组中97例患者经非手术治疗治愈，131例行手术治疗，非手术治愈率为100％。手术治疗131例中，死亡11例，手术治愈率91．6％（120／131），总治愈率95．2％（217／228）。结论准确进行伤情评估，早期诊断和合理的术式是闭合性肝损伤救治成功的关键。     

超声重点评估检查对急诊腹部闭合性损伤的诊断作用研究

目的 对急诊腹部闭合性损伤行超声创伤重点评估诊断的效果研究。方法 选取2019年3月至2022年1月绍兴市越城区人民医院收治的急诊腹部闭合性损伤者经手术治疗共66例作为研究对象，根据休克指数将66例患者分为2组，其中观察组24例，为失血性休克患者，对照组42例，为非失血性休克患者，对其均行超声超声创伤重点评估（FAST）及CT检查。比较FAST、CT检查对腹部闭合性损伤的诊断时间及诊断率，比较观察组与对照组IVC-CI指数情况。结果 所有患者经手术后均确诊为腹部闭合性单脏器损伤，66例患者中，肾损是21例，肝损伤17例，脾损伤14例，空腔脏器破裂10例，腹膜后血肿4例；FAST检查对各脏器损伤的诊断率与CT检查无明显差异（P>0.05）;FAST检查时间明显小于CT检查时间，差异具有统计学意义（t=8.0419,P<0.05）;FAST检查下，观察组IVC-CI指数平均为0.49±0.02，对照组IVC-CI指数平均0.32±0.03，观察组IVC-CI指数明显高于对照组，差异具有统计学意义（t=10.1368,P<0.05）。结论 超声FAST检查能在更短的时间内发...     

腹部闭合伤112例诊治体会

目的　总结腹部闭合伤的诊治体会。方法　 1990年 1月～ 2 0 0 0年 1月十年间 ,对我院闭合性腹部外伤 112例进行回顾性分析研究 ,单一脏器损伤 36例 ,多脏器或合并其它重要系统损伤 76例 ,非手术治疗 7例 ,手术治疗 10 5例。结果　治愈 10 6例 ,死亡 6例。结论　腹腔穿刺、X线、CT检查对诊断腹部闭合伤的准确率高。     

汶川地震德阳市腹部损伤的调查与分析

A magnitude of 8.0 earthquake struck on Wenchuan on May 12, 2008. Until July 1, 1393 injured persons had been admitted to Deyang People's Hospital. Of all injured persons, 32 were diagnosed with abdominal injury, including 18 men and 14 women. All the abdominal injuries were closed injury, and multiple abdominal viscera were involved in the abdominal injuries after the earthquake. Careful examination is crucial in preventing missed diagnosis. The incidences of the liver and spleen injuries were significantly higher than that of the intestine, and the reason may be that the liver and spleen are the parenchymal viscera. Diagnostic abdominocentesis can timely diagnose the parenchymal viscera with severe blood loss. Diagnostic peritoneal lavage combined with selective CT scan can timely diagnose the abdominal injuries with comparatively low cost.     

Clinical diagnosis and treatment of abdominal visceral injury complicated by craniocerebral injury

Objective : To improve the cure rate of patients with abdominal visceral injury complicated by craniocerebral injury. Methods: Clinical data of 176 cases of abdominal visceral injury complicated by craniocerebral injury were retrospectively analyzed. Results: In this series, 44 cases died and the mortality was 25.0%. The main cause of death is abdominal visceral injury combined with shock and severe craniocerebral injury. Conclusions: It is essential to improve the cure rate by accurate diagnosis at early stage. Abdominal paracentesis and CT should be performed promptly and dynamically. Priority should be given to the treatment of life-threatening injuries.     

Current advances in the surgical approach to abdominal trauma

The management of abdominal injury has changed dramatically during the past two decades.This review examines the historic perspectives and recent developments of diagnosis and treatment of liver injuries, splenic injuries, and pancreatic injuries. The incorporation of non-operative management for liver injuries has had a very positive effect on mortality. Likewise, splenic conservative therapy is routinely used. The early treatment of pancreatic injury has changed very little; however, the ability to recognize these difficult injuries has improved with higher quality CT scanning. The authors present their preferred treatment for these three common types of abdominal solid organ injury and present an illustrative case example.     

Computed tomography and nonoperative treatment for blunt abdominal trauma

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries.     

Computed tomography and nonoperative treatment for blunt abdominal trauma

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries.     

Non-operative treatment of abdominal gunshot injuries

BACKGROUND: Non-operative treatment is a management option that challenges the traditional mandatory laparotomy for abdominal gunshot injuries. METHODS: All published relevant clinical reports were retrieved by searching through the Medline database and manually. The theoretical arguments in favour of non-operative management as well as the results of the reviewed reports are analysed and evaluated. RESULTS AND CONCLUSION: Patients with proven non-penetration of the abdominal cavity can be offered conservative treatment with a satisfactory outcome. Greater caution should be exercised in the presence of a documented visceral injury until the safety of this option has been established by further clinical trials.     

Blunt liver trauma in children

From 1978 to 1988 228 children under 13 years of age with liver injury following blunt abdominal trauma were studied prospectively. Motor vehicle related accidents were responsible for 85 per cent of the injuries. Isotope liver scan established the diagnosis and identified the pattern of injury. Multiple injuries were seen in 157 patients--predominantly head injuries. The liver was the only intra-abdominal organ injured in 119 patients. There were 69 associated splenic, 33 renal, 21 pancreatic and 3 bowel injuries. There were two deaths (0.88 per cent). Management was non-operative in 215 patients, with resolution of the liver injury in 214. Blood was transfused in 92 patients (40 per cent) (mean volume 20 ml/kg). There were 10 complications; two liver abscesses responded to antibiotics. Follow-up showed complete resolution of the liver injuries. Eight underwent laparotomy because of instability, deterioration or other extrahepatic visceral injuries. All required blood transfusion (mean volume 30 ml/kg). There were eight complications following surgery.     

外伤后非治疗性剖腹探查67例分析

目的　探讨腹部外伤后发生非治疗性剖腹探查 (NTEL)的原因 ,对腹部外伤的早期诊断进行优化。方法　调查 6 7例曾有过NTEL的腹部外伤病人 ,了解其术中损伤病理诊断并分析发生的原因。结果　导致NTEL的主要病因有 :开放性腹部损伤 ;腹壁、网膜或系膜损伤 ,腹膜后血肿 ,肝脾外伤后导致的腹腔积血。结论　术前正确评估腹部外伤病人的脏器损伤能降低NTEL的风险     

放射性介入诊断治疗腹部闭合性损伤

目的 探索腹部实质性脏器损伤有效的诊断和非手术治疗方法。方法 对５１例腹部闭合性损伤进行选择性动脉造影诊断和栓塞治疗。结果 ５１例接受选择性动脉造影,其中实质性脏器损伤４２例（个）,均经动脉造影确诊,灵敏度,特异度和准确度均为１００％;空腔脏器或血管损伤１１例（个）,动脉造影对其中１０例（个）作出早期诊断,诊断率为９０．９％,总诊断率为９８．０％,４９例接受选择性动脉栓塞治疗,４６例治愈,治愈率９     

Liver trauma in children.

A review of our experience with urban children who sustained blunt abdominal trauma revealed that liver trauma occurred in one-third of all children. The cause of trauma, predominantly blunt in nature, led to a multitude of associated injuries which not only caused visceral and skeletal injury endangering the patient, but, more apparent even though less significant injuries delayed diagnosis and therapy of the underlying sever liver injury. Awareness of the possibility of liver injury in children with blunt abdominal trauma, prompt operative intervention wil injuries should significantly increase the salvage of these pediatric trauma victims.