非手术治疗小儿脾外伤10例

目的探讨小儿脾外伤非手术治疗的方法和适应症。方法对10例行非手术治疗的脾外伤患儿的临床资料进行回顾性分析。结果 10例患儿经非手术治疗均治愈,随访3～18个月,无一例出现并发症。结论非手术治疗小儿脾外伤是一种重要的治疗手段,只要严格掌握适应症,密切观察病情变化,并随时做好中转手术准备,此方法是安全可行的。     

小儿脾外伤保脾诊治分析

腹外伤中．脾脏是最容易受损伤的器官。儿童（尤其是小于5岁）失脾将会引起免疫缺陷乃至发生暴发凶险性感染（OPSI），故小儿脾外伤中应尽量避免行单纯脾切除手术。本文总结本院自1996年1月至2005年6月救治的32例保脾治疗的脾外伤病例．同期收治脾外伤共38例．占84-2％，均获成功。现结合小儿脾外伤特点对保脾诊治分析如下。     

脾外伤非手术治疗的影响因素探讨

目的 探讨非手术治疗脾外伤的选择条件。方法 就本组诊治２４例,将成功组与失败组进行对比分析和统计学处理。结果 成功２０例,占８３％,失败４例,占１７％,均为脾破裂延迟出血。成功组年龄平均２３．６岁,失败组３７．２５,Ｐ〈０．０５。入院时Ｂ超显示两组实质裂伤大小无明显差异,失败组手术证实均为Ⅲ型损伤。两组入院时血液动力学均平稳,Ｂ超示腹腔出血量成功组平均３１３．７５ｍｌ,失败组为２００ｍｌ,Ｐ〉０．０５。结论 Ｂ超只能对脾外伤的诊断和动态观察有价值,非手术治疗选择必须经ＣＴ对损伤程度评估,同时结合血液动力学、年龄、腹腔出血量等进行综合判断。     

选择性保脾治疗脾外伤的体会

目的总结脾外伤患者行保脾治疗的经验。方法回顾性分析197例脾损伤治疗的临床资料。结果 197例选择性非手术治疗87例,选择性手术保脾治疗110例,其中粘合胶加大网膜填压修补28例,脾动脉结扎脾修补24例,脾部份切除26例,脾切除自体脾片移植22例,腹腔镜脾修补10例。手术治疗发生并发症17例,其中粘连性肠梗阻4例,脾热10例,胰漏2例,脑梗塞1例。全部治愈出院。结论外伤性脾破裂保脾治疗,较好的保持了脾脏功能,值得推广。     

基层医院脾外伤治疗体会

脾脏深藏在左上腹腔,虽有胸壁及肋骨的保护,仍居腹腔脏器损伤的首位.据统计,脾损伤约占腹腔脏器损伤的30%左右.所以,脾损伤的诊治在脾外科中占重要位置[1].本院自1988年以来,收治各种原因的脾外伤166例结合本医院实际,依据具体情况选择了非手术治疗、保脾手术、脾切除或脾块移植等不同方案,救治成功率达到100%.     

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。     

小儿外伤后脑梗塞临床分析

我院1998．1-2000．12，共收治了小儿外伤后脑梗塞16例，均采用非手术治疗，效果满意，现报道如下。     

选择性非手术治疗脾外伤的护理

本院于2000年1月至2003年12月,共收住脾外伤病人72例,其中非手术治疗28例,效果满意.报告如下.     

脾外伤保脾治疗97例

我们1989年1月～2002年1月采用保脾方法治疗脾外伤97例，现报道如下。     

脾外伤继发脾脓肿3例处理体会

脾外伤继发脾脓肿３例处理体会山东枣庄市薛城区人民医院（２７７０００）梁兴国，丁绘武，于宝秀脾脓肿临床上少见，且多来自血行感染，由脾外伤直接继发感染引起的脾脓肿更为罕见。我院２０余年来共收治脾外伤继发脾脏肿（下称外伤性脾脓肿）３例。分析如下。１病历简介...     

胰腺损伤148例诊治分析

目的 探讨胰腺损伤的早期诊断、手术方式和并发症防治.方法 回顾分析20年间收治的胰腺损伤病历资料,包括性别、年龄、伤因、AAST分级、术式和疗效、并发症和死因等,并作统计学处理.结果 全组148例,手术132例,包括修补或仅引流、远端胰切除、远端胰(或囊肿)空肠Roux-n-Y吻合或其他内引流、憩室化、Whipple手术和损伤控制外科方法等术式.术后并发症发生率27.83%.Ⅲ～Ⅴ级与Ⅰ～Ⅱ级伤的胰瘘发生率差异有统计学意义(P＜0.01).病死率11.49%,死因主要为合并伤大出血(76.47%);而胰腺损伤级别间差异无统计学意义(P＞0.05).结论 首先控制合并伤大出血是提高胰腺损伤生存率的关键;术式取决于主胰管是否损伤,清除失活组织、充分外、内引流是胰腺损伤治疗的核心;早期诊断和正确的术式将明显减少并发症.     

Splenic trauma in children and techniques of splenic salvage

The increased risk of sepsis after splenectomy applies to any age for any reason. Splenic injuries consequently are now managed when possible by salvage procedures or nonoperative observation. This is not without controversy and in an attempt to define these injuries more appropriately and so predict optimal management, a quantitative and qualitative classification of presence and severity is presented, based on computed tomography. Type I injuries consist of localized capsular disruption or subcapsular hematomas, without significant parenchyma injury. Type II injuries consist of single or multiple capsular disruptions, with parenchymal injury that does not extend into the hilum or involve major vessels, with or without intraparenchymal hematoma. Type III injuries consist of deep fractures, single or multiple, that extend into the hilum and involve major vessels. Type IV injuries are those in which the spleen is completely shattered, fragmented, or separated from its normal blood supply. Added to this is the subclassification A for splenic injuries without associated intra-abdominal injuries; B for splenic injuries with associated intra-abdominal injuries, B₁ for injuries involving a solid viscus, B₂ for injuries involving a hollow viscus; and E for splenic injuries with associated extra-abdominal injuries.Surgical techniques for splenic salvage consist of the application of topical hemostatic agents or omentum with or without simple capsular sutures, direct suturing of capsule and parenchyma, ligation of individual or segmental vessels, partial splenectomy, application of an absorbable net or ladder, and large entire organ through- and-through sutures. These techniques are illustrated and alternatives to salvage are discussed.

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Resumen El aumento en el riesgo de sepsis observado después de la esplenectomía se aplica a cualquiera edad y a cualquier causa. Por ello las lesiones esplénicas son actualmente manejadas, en lo posible, con procedimientos que preservan el bazo o con observación no operatoria. Tal conducta no está libre de controversia y en un intento por definir en forma más apropiada este tipo de lesiones y con ello poder predecir su manejo óptimo, se presenta una clasificación cuantitativa y cualitativa basada en la tomografía computadorizada. Las lesiones tipo I consisten en rotura capsular localizada o en hematomas subcapsulares, sin daño significativo del parenquima. Las lesiones tipo II consisten en roturas capsulares únicas o múltiples, con daño parenquimatoso que no se extiende hasta el hilio ni afectan vasos mayores, con o sin hematoma intraparenquimatoso. Las lesiones tipo III consisten en fracturas profundas, únicas o múltiples, que se extienden hasta el hilio o que afectan vasos mayores. Las lesiones tipo IV son aquellas en las cuales el bazo está totalmente despedazado, fragmentado o separado de su vascularización normal. A lo anterior se añade la subclasificación A para lesiones esplénicas no asociadas con lesiones intraabdominales; B para lesiones esplénicas asociadas a lesiones intraabdominales, B₁ cuando una viscera mayor está afectada, B₂ cuando está afectada una víscera hueca; y E para lesiones esplénicas asociadas con lesiones extraabdominales.La técnica quirúrgica para preservación esplénica consiste en la aplicación de agentes hemostticos tópicos o de epiplón con o sin suturas capsulares, sutura directa de cápsula y parenquima, ligadura de vasos individuales o segmentarios, esplenectomía parcial, aplicación de una malla o escalera absorbible y suturas grandes a través de todo el órgano (through- and-through). Tales técnicas aparecen ilustradas, y se discuten las diferentes alternativas útiles para el salvamento esplénico.

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Résumé L'augmentation du risque infectieux après splénectomie s'observe aussi bien chez l'enfant que chez l'adulte et pour les mêmes raisons. Il en résulte que les lésions traumatiques de la rate doivent être traitées par des méthodes nonagressives ou par l'abstention en plaçant le blessé sous un contrôl médical attentif. Cette attitude a prêté à controverse. Pour définir de façon plus précise la blessure splénique, et pour choisir le traitement susceptible de lui être appliqué une classification reposant sur les données de la tomodensitométrie a été établie, classification quantitative et qualitative. Les blessures de type I consistent en la rupture localisée de la capsule ou dans la présence d'un hématome sous-capsulaire en l'absence d'atteinte du parenchyme. Les blessures de type II répondent à une ou à plusieurs ruptures capsulaires associées à une blessure du parenchyme qui n'atteint pas le hile de la rate, qui ne concerne pas des vaisseaux importants, qu'existe ou non un hématome intraparenchymateux. Les lésions de type III répondent à des fractures profondes, fractures uniques ou multiples qui s'étendent jusqu'au hile ou intéressent des vaisseaux importants. Les blessures de type IV répondent aux ruptures complètes de la rate de multiples fragments ou aux cas où la rate est privée de vascularisation. A cette classification principale s'ajoute une sous-classification: le type A représente des blessures spléniques sans lésion intra-abdominale associée. Le type B répond aux lésions spléniques s'accompagnant de lésions traumatiques intra-abdominales. Il est qualifié de B₁ si un viscère plein est intéressé, de B₂ si un viscère creux est en cause. Le type E répond aux lésions traumatiques spléniques associées à des lésions traumatiques extra-abdominales. Le traitement conservateur de la rate consiste à employer des agents hémostatiques locaux ou le grand épiploon en s'aidant ou non de sutures de la capsule, et du parenchyme, de la ligature d'un vaisseau, de l'emploi d'un filet en matériel absorbable ou de sutures de part en part du parenchyme splénique. Ces techniques sont illustrées dans l'article présenté.

     

Urban trauma: an analysis of 1,116 paediatric cases

Over a 2-year period 1,116 children admitted to an urban teaching hospital were studied prospectively. The overall group was analysed as to the nature of the injury and a subgroup of seriously injured children was identified and further analysed. All deaths were examined as to their cause and possible preventable as well as salvageable factors. The predictive value of the Trauma Score (T.S.) and Method of Injury (M.O.I.) were evaluated for their prospective prediction of serious injury as determined by the Injury Severity Score and outcome. Most of the children were not seriously injured, with the most common injury being due to a fall (57%) and involving a single injury to the upper limb. With the subgroup of 143 children (13% of the total) who suffered serious injuries, the cranial cavity (90%) was the most common site of injury, occurring most often in pedestrians (31% of the total injured). There were 16 deaths in the series, representing 1.4% of all paediatric trauma admissions and 11% of the admissions who were seriously injured. All deaths were related to motor vehicle accidents and associated with serious head injury. A Trauma Score less than or equal to 12 accurately included all deaths but when correlated with the I.S.S., the Trauma Score had a specificity of 99% and a positive predictive value of 86%; its sensitivity was only 27%. The Method of Injury was associated with an overtriage rate of 300% in relation to the I.S.S.. Of children admitted following pedal cycle accidents only 9% were wearing helmets. Of car occupants injured, 39% were unrestrained.(ABSTRACT TRUNCATED AT 250 WORDS)     

肝外伤的诊治体会(附55例报告)

目的 总结肝外伤的诊断和治疗经验.方法 回顾55例肝外伤患者的临床资料.结果 55例肝外伤中Ⅰ～Ⅱ级18例,Ⅲ级15例,Ⅳ级17例,Ⅴ级5例;采用非手术治疗31例,均痊愈;于术治疗24例,痊愈22例,自动出院2例.结论 肝外伤诊断以伞腹B超和腹腔穿刺为首选检杏,血液动力学稳定时可行腹部CT平扫或加增强扫描对判断是否行于术治疗彳丁帮助.目前,肝外伤的治疗主要考虑两个方面:血液动力学的稳定性和外伤的性质:钝挫伤或贳通伤;在判断是否行保守治疗时,血液动力学稳定性比肝外伤分级相对更重要.对血液动力学稳定的Ⅰ级、Ⅱ级和部分Ⅲ级钝性肝外伤可存严密连续临测下行非于术治疗;根据m液动力学变化和伤情判断及时中转于术;对血液动力学不稳定的部分Ⅲ级、Ⅳ级和Ⅴ级严重肝外伤以下术治疗为宜.早期复苏、有效止血、充分引流和防治术后并发症足降低严重肝外伤病死率的关键.     

Chest injuries in children: an analysis of 100 cases of blunt chest trauma from motor vehicle accidents.

One hundred twenty-eight cases of chest injury were seen in a Paediatric Trauma Unit over a 5 1/2-year period. One hundred patients sustained motor vehicle accident (MVA)-related blunt chest injuries, 91 of them as pedestrians. Nine children had blunt chest injuries from falls, 10 had stab wounds (3 assault, 7 accidental), and 9 had gunshot injuries (6 from birdshot used by police during civil disturbance). MVA-related injuries were studied separately, as an etiologically homogeneous group. Sixty-five of these patients were under the age of 6. All but 3 also had serious extrathoracic injuries. The mean injury severity score (ISS) in MVA-related injuries was 25. Eight patients died, all with an ISS of 34 or more, 7 of whom had fatal head injuries. In MVA-related injuries, pulmonary contusion (n = 73) was the most frequent lesion seen, followed by rib fracture (n = 62), posttraumatic effusion (n = 58), pneumothorax (n = 38), and pneumatocele (n = 5). In MVA-related injuries, 18 children required ventilation. Thirty-nine (69%) of 56 children with radiologically evident posttraumatic pleural effusion had intercostal chest drainage. Analysis suggests that lung injury is a central event in MVA-related blunt chest trauma. Primary lung injury, radiologically visible as contusion, is complicated by hematoma, posttraumatic effusion, and pneumothorax.     

Purulent pericarditis in children: an analysis of 28 cases

Weir, E. K., and Joffe, H. S. (1977).Thorax, 32, 438-443. Purulent pericarditis in children: an analysis of 28 cases. Bacterial pericarditis was diagnosed in 28 children under the age of 13 years during a five-year period at one hospital. The diagnosis was established clinically in 26 cases; in two the condition was first recognized at necropsy. Staphylococcus aureus was isolated in 22 patients, including all 12 with associated osteitis. The other principal primary condition was pneumonia.     

Abdominal injuries in children: an analysis of 348 cases

Three hundred and forty-eight children from Skaraborg County, Sweden, admitted to hospital with abdominal injuries over a 30-year period (1951-1980), have been analysed and compared with all patients with abdominal injury (1407) admitted to hospital from the same area during the same period. The number of children admitted in the second half of the period was greater than during the first but the proportion of children compared with adults was considerably reduced. During the period abdominal injuries due to car accidents increased in adults but not in children. The most frequent cause of abdominal injury in children was a bicycle accident. Abdominal injury due to sport also increased over the period. Mortality decreased, with no deaths in the past 10 years, compared with 8.6 per cent mortality in the first 10 years of the period.