Transurethral surgery and persistent urinary infection: effect of a single preoperative dose of cefuroxime

To evaluate the efficacy of cefuroxime, a second generation cephalosporin, in minimizing the risk of per and postoperative infection complications in patients with urinary tract infection undergoing transurethral surgery, 86 patients (ASA I, II) with persistent urinary tract infection despite antibiotic therapy were studied. A double blind protocol was followed. Patients were randomly assigned to receive 10 minutes before surgery either I.V. cefuroxime (1.5 g) (group C, n = 39) or placebo (group P, n = 47) the incidence of positive peroperative systematic blood cultures was lower in group C (9.7%) than in group P (25.2%) (p less than 0.001). The incidence of postoperative blood cultures taken when clinical septic signs were present, was significantly lower in group C (0%) than in group P (21.7%) (p less than 0.05). However neither the incidences of both postoperative urinary tract infection at the 48th postoperative hour and the clinical signs of bacteraemia including fever nor the average length of hospitalization were significantly different in the 2 groups. This lack of significant clinical benefit was not explained by the pharmacokinetic properties of this antibiotic. Thus, preoperative administration of a single dose of cefuroxime, reduces the incidence of per and postoperative bacteraemias in ASA I-II patients with persistent urinary tract infection.     

腹腔镜与开腹手术治疗小儿复杂性阑尾炎的对比研究

目的 对比腹腔镜阑尾切除术与开腹阑尾切除术治疗复杂性阑尾炎的疗效。方法 总结2016年8月~2017年8月在新乡医学院第一附属医院行手术治疗的91例复杂性阑尾炎患儿资料,根据入院顺序随机将患儿分成观察组与对照组。观察组42例行腹腔镜阑尾切除术,对照组49例行开腹阑尾切除术,统计分析两组的手术时间、术中出血量、疼痛程度、术后恢复情况、并发症发生率、住院时间及总费用等指标,比较有无组间差异。结果 LA组在术后疼痛评分、下床活动时间、肠道功能恢复时间、总并发症、切口感染、术后肠梗阻、住院时间、总费用方面优于OA组,差异有统计学意义。OA组在手术时间上优于LA组,差异具有统计学意义（P＜0.05）。两组在术中出血量、腹腔残余感染方面,虽然LA组低于OA组,差异无统计学意义（P＞0.05）。 结论 LA治疗小儿复杂性阑尾炎安全有效,与OA相比具有手术创伤小、术后恢复快、术后并发症少,住院时间短,住院总费用低等优势。     

腹腔镜下急性胃十二指肠穿孔修补术对胃肠道功能的影响

目的 分析腹腔镜下急性胃十二指肠穿孔修补术对胃肠道功能的影响。方法 选择2016年5月~2019年5月在我院诊治的急性胃十二指肠穿孔患者90例,采用随机数字表法分为对照组和观察组,各45例。对照组采用传统开腹急性胃十二指肠穿孔修补术,观察组采用腔镜下急性胃十二指肠穿孔修补术。比较两组手术时间、术后VAS评分、肛门排气时间、肠鸣音恢复时间、胃蛋白酶（PGⅠ、PGⅡ）水平、胃肠道激素（GAS、VIP、MOT）水平以及并发症发生率。结果 观察组手术时间、术后VAS评分、肛门排气时间、肠鸣音恢复时间均优于对照组,差异有统计学意义（P＜0.05）;治疗后两组PGⅠ、PGⅡ、GAS、VIP、MOT水平均高于治疗前,且观察组高于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为2.22%,低于对照组的22.22%,差异有统计学意义（P＜0.05）。结论 腹腔镜下急性胃十二指肠穿孔修补术患者创伤小,术后胃肠功能恢复快,且并发症少,利于患者的术后恢复。     

Spontaneous Lymphocyte Proliferation during Trauma and Infection

Spontaneous lymphocyte proliferation (SpP), measured in vitro as the rate of [14C]thymidine incorporation in blood lymphocytes, was investigated in non-infected postoperative patients, infected postoperative patients, and healthy volunteers, with 72, 24, and 3 h of lymphocyte culture. With 24-h cultures, infected postoperative patients showed 17-fold higher SpP than non-infected postoperative patients (2527 +/- 1552 versus 151 +/- 77 cpm, mean +/- SD, P less than 0.001) and 37-fold higher SpP than healthy volunteers (P less than 0.001). Postoperative patients without infection had twice as high SpP as healthy volunteers (P less than 0.001). Lymphocytes harvested after 24 h of cell culture showed significantly higher SpP than corresponding values at 72 and 3 h, in patients as well as in healthy volunteers (P less than 0.01). Infected postoperative patients showed a higher SpP than non-infected patients after only 3 h of cell culture (270 +/- 192 versus 48 +/- 10 cpm, P less than 0.001). An inverse correlation was observed between the level of SpP and body temperature in patients with postoperative infection (r = -0.62, P less than 0.05). The results indicate that lymphocytes are activated by uncomplicated surgery and particularly by postoperative infection, and that characteristics of SpP are reproducible in short cell-culture periods, which suggests that in vitro measurements of SpP may be of value in the detection of severe postoperative infection.     

剖腹探查在高原地区腹部外伤中的临床应用研究

目的研究剖腹探查在高原地区腹部外伤中的临床应用,以提高剖腹探查的阳性率。方法临床入选411例腹部外伤患者,分别分析剖腹探查阳性患者组与剖腹探查阴性患者组的白细胞计数及D-二聚体、C反应蛋白的水平以及主要的临床表现情况。结果本研究探查阴性率为40.88%,探查性阳性率为59.12%,其中肝脾破裂62例,肠破裂51例,后腹膜血肿50例,肠系膜裂伤及血肿49例,肠挫伤31例,病死率为1.94%。在白细胞计数方面,探查阴性组与探查阳性组之间没有统计学差异（P〉0.05）;而在C反应蛋白及D-二聚体的水平方面,探查阴性组与探查阳性组之间具有统计学差异,且阳性组要显著高于阴性组（P〈0.05）。而在腹内脏器疝出和腹痛临床表现方面,探查阴性组与探查阳性组之间均无统计学差异（P〉0.05）;而在气腹、休克、腹穿阳性、腹膜炎及消化道出血等临床表现方面,探查阳性组明显较探查阴性组发生率高（P〈0.05）。结论 C反应蛋白及D-二聚体水平、气腹、休克、腹穿阳性、腹膜炎及消化道出血等临床表现方面可能为临床选择剖腹探查提供一定的依据,据此可以尽可能的避免一些不必要的医疗损伤。     

Intestinal ischemia

CONTEXT: As rejection in renal transplantation has become better controlled, gastrointestinal complications have become increasingly important. Ischemic colitis and colonic perforation are the most common of these lesions, contributing to morbidity and mortality in the early postoperative period. OBJECTIVE: We undertook this study to identify factors contributing to the risk of intestinal ischemia in patients undergoing renal transplantation and to define circumstances that may affect that risk. METHODS: We studied 356 patients undergoing renal transplantation during a 40-month period. We reviewed medical records, surgical pathology reports, autopsy reports, and pathology slides. RESULTS: Eleven (3.1%) of the patients developed ischemia of the small or large bowel or both within 20 days after transplantation, and 6 (54.5%) died as a result. Ten of these patients had received cadaveric kidneys and were older than 40 years. There was no sex predilection. The most common segment involved was the terminal ileum and ascending colon. We discuss possible reasons underlying these observations in this article. CONCLUSION: The mechanism behind posttransplantation intestinal ischemia is multifactorial, but regardless of etiology, it is important to emphasize the risk of intestinal ischemia in patients who develop abdominal symptoms during the early posttransplantation period, particularly in patients older than 40 years who have received cadaveric kidneys.     

Horizontal transmission of hepatitis B virus infection in household contacts, Pune, India

The study was undertaken to detect the risk of infection, if any, among 193 household contacts of 40 hospitalised hepatitis patients (group I) with hepatitis B surface antigen (HBsAg) in their blood. As a control group, 103 household contacts of 27 hospitalised hepatitis patients who were negative for HBsAg (group II) were investigated. The family contacts of the former group had a significantly higher prevalence of HBV infection than those of the latter group (P less than .001). Significant differences were observed both in the prevalence of HBsAg (P less than .05) and antibody to HBsAg (anti-HBs) (P less than .025) between the two groups. IgM antibody to hepatitis B core antigen (anti-Hbc-IgM) was detected in 32 out of the 39 (82%) sera tested from the patients of group I with HBsAg. A statistically significant difference (P less than .005) of HBV prevalence was also found in the contacts of these 32 patients suffering from acute hepatitis B as compared to the contacts of the patients of group II. Overall, the children of the first group showed a significantly higher prevalence of HBsAg as compared to the second group. All the children with HBsAg were positive for HBeAg also, but were negative for anti-HBc-IgM. Anti-HBs was detected in a significantly larger number of adult females. Spouses were found to be affected more than other relatives. A significant difference (P less than .025) was noted in the number of families having HBV markers in group I (80.0%) as compared to those in group II (48.1%).(ABSTRACT TRUNCATED AT 250 WORDS)     

腹部术后肺部感染47例临床分析

目的探讨腹部术后肺部感染的原因，以降低肺部感染率。方法对572例腹部手术的病例资料进行回顾性分析，探讨47例腹部术后肺部感染的相关因素。结果572例腹部术后肺部感染47例．感染率8．22％。年龄〉60岁患者的感染率为17．58％，远高于其他低龄两组（P〈0．05）；上腹部术后感染率19．87％较下腹部术后肺部感染率4．04％高，两者差异有统计学意义（P〈0．01）；原有呼吸系疾病患者肺部感染发生率17．02％与无原发呼吸系疾病患者肺部感染率6．49％比较，差异有统计学意义（P〈0．05）；留置胃管患者的肺部感染率26．38％远高于未留置管者5．6％，差异有统计学意义。以上因素导致腹部术后肺部感染患者住院时间延长。结论腹部术后肺部感染与年龄、手术部位、原有呼吸系疾病、留置胃管等因素相关，因此应积极预防，控制感染．减轻患者经济负担。     

基于ERAS理念的腹腔镜胰十二脂肠切除术在老年壶腹周围癌患者治疗中的应用

目的 探讨加速康复外科（ERAS）围手术期管理下的腹腔镜胰十二指肠切除术（LPD）在老年壶腹周围癌患者治疗中应用的可行性。方法 回顾性研究。纳入2015年1月—2019年12月蚌埠医学院第一附属医院肝胆外科壶腹周围癌患者127例,其中男71例、女56例,年龄17~81（62.2±11.5）岁。将患者按年龄分为老年组（>65岁,61例）和非老年组（≤65岁,66例）。2组患者均接受LPD治疗,并按照标准的ERAS围手术期管理方案进行个体化管理,术后随访1年以上。对比分析2组患者以下观察指标：（1）患者性别、体质量指数、美国麻醉协会（ASA）评分及合并基础疾病等基线资料;（2）肿瘤的部位、大小（长径）、数目、切缘阳性率,以及有无淋巴、血管和神经浸润等肿瘤病理学特征;（3）手术时间、住院时间、术中出血量等围术期指标,包括术后腹腔出血、胃延迟排空、腹腔感染、胆瘘和胰瘘等在内的术后主要并发症（Clavien-Dindo分级≥Ⅲ级）发生率,围手术期死亡率、患者生存率和生存时间等临床病理特征;（4）采用logistic多因素回归分析患者围手术期死亡的危险因素。结果 2组患者均顺利完成LDP手术,围手术期均无心血管事件发生。患者术后出血、胃延迟排空、腹腔感染、术后胰瘘、术后胆瘘等主要并发症发生率组间比较,差异均无统计学意义（P值均>0.05）。非老年组患者肿瘤长径为2（2.0,3.6）cm,大于老年组的2（1.5,3.0）cm,差异有统计学意义（Z=-2.40,P=0.017）;2组患者其余的肿瘤病理组织学特征、基线资料,以及包括术后主要并发症的各临床病理特征比较,差异均无统计学意义（P值均>0.05）。logistic多因素回归分析显示,术后腹腔出血是影响患者围手术期死亡的危险因素（比值比11.158, 95%可信区间1.664~74.836, P=0.013）,而包括年龄、性别、ASA评分和其他主要并发症等则不是患者围手术期死亡的危险因素（P值均>0.05）。结论 ERAS理念下的老年壶腹周围癌患者腹腔镜胰十二指肠切除术安全可行,年龄不应成为腹腔镜胰十二指肠切除术的禁忌。     

腹部肿瘤术后采取混合糖溶液营养支持的临床观察

目的探讨腹部肿瘤患者术后静脉应用混合糖溶液对其营养代谢指标的影响。方法选取腹部肿瘤且行根治术的成年患者56例,随机分为混合糖营养支持组和单糖营养支持组两组,术后3d禁食并分别持续静脉输注10.5%的混合糖溶液或10%的葡萄糖单糖溶液1000ml/d,测末梢血血糖并据此调整胰岛素用量,记录血糖、胰岛素情况且每天检测C反应蛋白（C-reactive protein,CRP）的水平。结果术后72h内,两组患者术后的血糖水平都较术前有所增高,在术后使用胰岛素情况下两组之间的血糖水平差异无统计学意义（P〉0.05）;混合糖组胰岛素用量显著低于单糖组（P〈0.01）;两组患者的CRP水平都较术前有所升高,单糖组较混合糖组升高更加明显（P〈0.05）。结论腹部肿瘤根治术的患者,术后禁食并应用混合糖溶液作为糖源供能,机体血糖波动较小。此外,在减轻术后应激性炎症反应方面也起到了一定的作用。     

全胸腔镜手术治疗婴幼儿先天性膈疝的临床研究

目的 探讨全胸腔镜手术治疗婴幼儿先天性膈疝的临床效果以及安全性、可行性。方法 回顾性研究。纳入2015年4月—2021年3月南京医科大学附属儿童医院小儿心胸外科97例先天性膈疝患儿的临床资料。其中男61例、女36例,年龄2 d~3岁[（3.1 ± 7.2）个月];左侧51例,右侧46例。所有患儿均在胸腔镜下行膈疝修补术,术中观察疝内容物有无坏死、穿孔、损伤等情况,记录胸腔镜手术患儿的手术时间、术中出血量、术后胸腔引流量、引流管拔除时间、手术后住院时间。术后定期随访,观察切口感染、膈膨升、乳糜胸、气胸、肠梗阻等相关并发症发生情况,以及术后膈疝复发情况。结果 97例患儿均在全胸腔镜下顺利完成手术,无一例中转开胸手术。术中见疝囊内容物多为脾脏、胃、大网膜、结肠、小肠等,无肠穿孔坏死、肝脾出血等情况发生。手术时间75~150（90.5 ± 12.1） min,手术出血量6~15（8.3 ± 0.6） mL,术后胸腔引流量30~130（41.2 ± 7.6） mL,引流管拔除时间3~10（6.1 ± 1.3） d,手术后住院时间10~18（11.7 ± 2.1） d。住院期间因缝线脱落导致复发2例,再次行胸腔镜手术治愈;1例患儿术后第1天因左肺严重发育不良死亡。术后96例患儿均获随访,随访时间1个月~3年,平均9.2个月。随访期间无切口感染、乳糜胸、呼吸道感染、肠梗阻、肠穿孔等并发症发生,患儿生长发育良好,无一例复发。结论 全胸腔镜手术治疗婴幼儿先天性膈疝具有手术视野暴露清楚、术中出血量少、术后并发症少、住院时间短等优点,短期疗效可靠,安全可行。     

Quantitative histology in giardiasis.

The Weibel graticule was used to assess quantitatively histological changes in proximal jejunal mucosal biopsies from patients with Giardia lamblia infections. Most had malabsorption. A group of patients who had mild abdominal symptoms but no intestinal infection and normal absorption were the controls. There were significant differences in mean surface area (SA) measurements between patients with giardiasis and severe malabsorption and controls (P less than 0.001) and infected patients with normal absorption (P less than 0.05). SA measurements correlated significantly with D-xylose excretion results (r = 0.55; P less than 0.01) and daily facal fat output (r = -0.61; P less than 0.001). Significant correlations between duration of symptoms and SA measurements (r = 0.43; P less than 0.05) and D-xylose excretion (r = 0.43; P less than 0.05) in giardiasis suggest that histological and functional impairment are maximal soon after infection and resolve in time. Treatment with metronidazole or mepacrine was associated with a significant increase in SA (P less than 0.05) in patients with severe malabsorption but there was little change in SA in a similar group of patients who received tetracycline. The Weibel graticule was found to be useful in assessing the severity of histological changes and in following changes after treatment.     

腹腔镜子宫全切除术与开腹手术的临床效果分析

目的 研究分析子宫切除术中分别运用常规开腹式切除以及腹腔镜式切除的临床效果。方法 选取2014年5月~2016年5月本院收治的65例行腹腔镜子宫全切除术患者作为实验观察组,另选取65例行传统子宫全切除术患者作为常规对照组,对比分析两组患者实施手术后各项观察指标及并发症发生情况。结果 实验观察组患者的术中出血量、肛门排气时间、术后下床活动时间、住院时间均显著优于常规对照组,差异具有统计学意义（P＜0.05）;而在术后镇痛方面,实验观察组人数明显少于常规对照组,并且创口均为甲级愈合,两组间差异具有统计学意义（P＜0.05）。实验观察组患者术后切口感染、切口液化发生率均显著低于常规对照组,差异具有统计学意义（P＜0.05）。结论 使用腹腔镜子宫全切除手术具有对患者造成的创伤小、术中出血量较少、对腹腔内环境的影响小、术后恢复速度快且无明显瘢痕等显著优势,具有较高的临床推广价值。     

腹腔镜联合输尿管镜治疗胆总管结石的临床疗效

目的 探讨腹腔镜联合输尿管镜治疗胆总管结石的临床疗效。方法 选取2016年1月~2018年7月我院治疗的胆总管结石患者68例,按照随机数字表法分为对照组和研究组,各34例。对照组行传统开腹手术治疗,研究组行腹腔镜联合输尿管镜治疗。比较两组手术时间、术中出血量、术后患者肠功能恢复时间、住院时间以及T管拔除时间、结石一次性清除率和术后并发症发生情况。结果 两组手术时间比较,差异无统计学意义（P＞0.05）;研究组术中出血量,术后患者肠道功能恢复时间、住院时间以及T管拔除时间均优于对照组,差异有统计学意义（P＜0.05）。研究组结石一次性清除率为91.18%,低于对照组的94.12%,但差异无统计学意义（P＞0.05）。研究组术后并发症发生率为5.88%,低于对照组的23.53%,差异有统计学意义（P＜0.05）。结论 腹腔镜联合输尿管镜治疗胆总管结石,具有创伤小、术中出血量少,术后恢复快及并发症少等优点,同时具有较高的临床应用价值。     

Intestinal necrosis related to administration of cation exchange resin without sorbitol: A retrospective analysis of 61 patients with end‐stage renal diseases

Intestinal necrosis associated with cation exchange resin (CER) is considered related to sorbitol, but it has been reported even in patients receiving CER alone. This study was performed to identify the risk factors of CER‐related intestinal necrosis. The pathological database of 61 end‐stage renal disease patients with surgical intervention for intestinal perforation was reviewed. The correlations between CER treatment and clinicopathological factors were studied among three groups: (i) patients administered CER and with CER at the perforation site (n = 23), (ii) patients administered CER with undetected CER at the perforation site (n = 12) and (iii) patients not administered CER (n = 26). The majority of the perforation site in group 1 was in the sigmoid colon (82.6%) with significantly higher average age and more frequent CER adhesion rates to the mucosa around the perforation site than group 2. The laxative administration rate in group 1 was significantly higher than group 3 and tended to be higher than group 2. The incidence of CER‐related intestinal necrosis was estimated at 0.57%. CER should be used with extreme caution in elderly patients with passage disturbance.     

血嗜酸性粒细胞计数与冠状动脉旁路移植手术后肺炎风险（英文）

目的:研究血嗜酸性粒细胞计数与冠状动脉旁路移植手术患者术后肺炎风险的关系。方法:收集2008年~2017年在我院进行冠状动脉旁路移植手术的613例患者资料进行分析,比较不同血嗜酸性粒细胞计数患者术后肺炎发生率及住院死亡率,采用多因素回归分析明确患者术后肺炎的危险因素。结果:研究共纳入582例患者,其中220例患者血嗜酸性粒细胞比例2%(低血嗜酸性粒细胞组),362例患者血嗜酸性粒细胞比例≥2%(高血嗜酸性粒细胞组)。低血嗜酸性粒细胞组术后肺炎发生率(14.1%,31/220)明显高于高血嗜酸性粒细胞组(6.4%,23/362,P=0.002),而2组患者住院死亡率无明显差异。多因素回归分析结果显示低血嗜酸性粒细胞计数(OR=3.521,95%CI:1.213~10.223,P=0.021)、鼻胃管(OR=6.490,95%CI:2.757~15.280,P0.001)和机械通气时间≥24 h(OR=3.496,95%CI:1.156~10.178,P=0.035)为术后发生肺炎的独立危险因素。结论:低血嗜酸性粒细胞计数患者冠状动脉旁路移植手术后发生肺炎的风险升高。     

Dip slide culture of intraoperative peritoneal irrigation fluid for prediction of septic complication in elective colorectal surgery.

A controlled prospective study of a simplified technique, the dip slide culture method, for assessment of bacterial concentration in peritoneal irrigation fluid at the end of an elective colorectal operation is presented. The prediction of postoperative surgical infection based on intraoperative culture was compared between this method and a standard streak-plate technique in 190 patients. One gram of metronidazole was given intravenously as prophylaxis on induction of anesthesia and 12 h postoperatively. Intraoperative growth of members of the family Enterobacteriaceae or Staphylococcus aureus was strongly correlated to infection (P less than 0.001). By using this finding as a single criterion for the prediction of sepsis, sensitivity and specificity for the dip slide method were 70.8 and 94.3%, respectively, compared with 79.2 and 94.6%, respectively, for the streak-plate method. Of the 24 infections, 20 (83.3%) were correctly predicted when a combination of the two methods was used. An increasing number of Enterobacteriaceae or S. aureus in the dip slide culture resulted in a steady rise in the rate of infections from 5.7% at 0 CFU to 57% at greater than or equal to 80 CFU compared with 4.1% at 0 CFU/ml and 45.4% at greater than or equal to 800 CFU/ml with the streak-plate method. The differences were statistically significant at the greater than or equal to 5 CFU level with regard to wound infection (P less than 0.001) and deep surgical infection (P less than 0.01). It is concluded that the dip slide is a simple, rapid, and reliable method for the routine assessment of bacterial contamination in colorectal operations.     

腹腔镜完全腹膜外腹股沟疝修补术与填充式无张力疝修补术的比较

目的观察腹腔镜完全腹膜外腹股沟疝修补术与填充式无张力疝修补术的临床疗效。方法将240例行腹股沟疝修补术的患者,随机分为腹腔镜组和开腹手术组,观察两组患者手术中及术后并发症的发生情况。结果两组患者手术均顺利,术后随访1-4年未见复发。腹腔镜组术后疼痛较轻,住院时间短,两组比较差异性明显(P<0.05);手术时间、术中出血、血肿发生、尿潴留、尿路感染、肺部感染两组比较差异性不明显(P>0.05)。结论腹腔镜腹股沟疝修补术可以取得与开腹手术相同的效果,其术后疼痛轻微,恢复时间快,更具有较好优势,值得临床推广应用。     

PFNA与Gamma钉治疗老年股骨转子间骨折的疗效比较

目的观察股骨近端防旋加锁髓内钉(PFNA)与Gamma钉治疗老年股骨转子间骨折的临床疗效,探讨PFNA治疗老年股骨转子间骨折的应用价值。方法将100例老年股骨转子间骨折分为PFNA组(54例)和Gamma钉组(46例),分别采用PFNA和Gamma钉治疗,观察2组患者不同年龄段手术情况、术后恢复情况及手术并发症情况。结果 PFNA组各年龄段手术时间、术中出血量均明显低于Gamma钉组同年龄段患者(P0.05);2组患者骨折愈合时间比较无显著差异(P0.05);PFNA组75岁以上患者Harris评分明显高于Gamma钉组(P0.05);PFNA组术后并发症明显低于Gamma钉组(P0.05)。结论 PFNA治疗老年股骨转子间骨折具有固定牢靠、防旋能力好、手术创伤小、并发生少等优点,且适合各年龄段股骨转子间骨折。     

腹部空腔脏器损伤156例分析

目的探讨提高腹部空腔脏器损伤诊治水平的方法。方法回顾性分析156例腹部空腔脏器损伤患者的临床特点。结果延迟诊断(伤后至手术时间>24h)3例,术后并发切口感染12例,切口裂开2例,肺部感染4例,肠间脓肿1例,合并多器官功能不全综合征死亡5例,5例均为合并伤,其中4例首次手术探查遗漏空腔脏器损伤。结论早期诊断、探查全面、术式合理、以及完善的围手术期管理是减少并发症、降低死亡率的重要因素。