腹部闭合性损伤的腹腔镜诊断和治疗(附116例报告)

目的探讨总结应用腹腔镜技术诊断和治疗腹部闭合性损伤的临床效果.方法 116例腹部闭合性损伤病例在全麻、腹腔镜下行诊断和治疗.结果 116例均于腹腔镜下明确诊断并进行治疗.其中38例出血停止,36例腹腔镜下止血成功,8例腹腔镜行脾切除术.避免剖腹手术82例,占70.7%.结论腹腔镜应用于腹部闭合性损伤的诊断和治疗是可行的,且较腹腔穿刺、腹腔灌洗及剖腹探查简便宜行.     

37例妊娠期腹部闭合性损伤的临床分析

目的探讨妊娠期腹部闭合性损伤的特点及救治方法：方法总结1993年6月～2003年6月收治的37例妊娠期腹部闭合性损伤的临床资料；结果37例均进行手术治疗，其中早孕合并肠破裂2例、腹膜后血肿1例在腹腔镜下直接处理；其余34例均行开腹手术，其中8例因胎盘早剥和(或)增大的子宫阻碍腹内脏器损伤的处理而行刮宫取胎术。37例中治愈33例(89％)，死亡4例(11％)。术后并发症发生率16％(6／37)，其中腹腔感染2例(5％)，肺部感染3例(8％)，多器官功能衰竭1例(3％)：结论妊娠期腹部闭合性损伤除考虑产科疾病外应高度警惕腹腔脏器的损伤。妊娠期腹部闭合性损伤准确诊断和及时处理，将给母婴的抢救赢得时间。     

手术治疗腹部闭合性损伤80例

目的：探讨腹部闭合性损伤的手术治疗。方法：回顾性分析我院近年来收治的80例腹部闭合性损伤患者的临床资料。结果：80例腹部闭合性损伤的患者,经剖腹探查手术治疗,成功治愈74例,治愈率为92.5%,死亡6例,死亡率为7.5%。其中,2例患者死于肝破裂大出血,2例患者死于颅脑外伤,3例患者死于多脏器衰竭。结论：对于腹部闭合性损伤,临床医生必须细致检查和严密动态观察,以便于早期诊断,并提出合理的治疗方案,以提高手术治疗效果,减少术后并发症的发生,降低死亡率。     

腹部闭合性损伤78例诊治分析

腹部闭合性损伤早期诊断比较困难,如延误诊治,易导致出血性休克或空腔脏器穿孔而危及生命。我们自1998～2004年共收治腹帮闭合性损伤78例,现分析报告如下。     

682例腹部闭合性损伤手术救治结果分析

腹部闭合性损伤情况复杂、病情严重 ,给临床诊治造成一定困难。若不及时正确处理 ,常造成严重后果 ,甚至危及生命。总结我院 1991年 10月至 2 0 0 1年 10月急诊手术救治腹部闭合性损伤6 82例的经验 ,报告如下。临　床　资　料本组男 4 6 3例 ,女 2 19例 ;年龄 1.5～ 78.5岁。伤因 :交通伤 4 30例 (占6 3.0 % ) ,打击伤 95例 (占 13.9% ) ,坠落伤 89例 (占 13.0 % ) ,其他伤 6 8例 (占10 .0 % )。合并休克 5 39例 (占 79.0 % )。术前腹腔穿刺检查 6 0 0例 ,B超检查 5 82例 ,X线及CT检查 6 2 0例。本组病例均实施了急诊手术。术前给予输液、…     

217例腹部闭合性损伤诊治体会

我院于1991年8月至2001年8月共收治腹部闭合性损伤患者217例,取得了满意的疗效,现对病例进行回顾性分析,总结腹部闭合性损伤的诊治方法。1 临床资料 本组217例,男性148例,女性69例,年龄6～65岁。交通事故伤161例,坠落伤39例,其他(包括挤压伤、踩伤等)17例。其中脾脏损伤102例,肝脏或胆道损伤78例,胃或肠道损伤17例,肾脏损伤18例,胰腺损伤2例。114例患者有合并伤,21例为2处或2处以上合并伤。合并伤包括肋骨骨折45例,脊柱或四肢骨折39例,骨盆骨折18例,血气胸25例,膀胱     

腹部闭合性损伤78例救治体会

腹部损伤（abdominal injury）为外科常见的严重损伤，无论平时和战时都较常见。临床上可分为开放性和闭合性损伤两大类。多数腹部损伤因涉及腹内脏器损伤而伤情严重，死亡率为5％-10％。腹部闭合性损伤（blunta bdominal trauma，BAT）最关键的是确定有无内脏损伤，因常伴随有颅脑伤、胸外伤、脊柱骨盆伤等，可掩盖病史和体征，使其诊断不易明确。     

腹部闭合性损伤112例临床诊治体会

1990年9月—2004年12月我们治疗腹部闭合性损伤112例,现将我们的诊断和治疗体会介绍如下。1临床资料1.1一般资料男90例,女22例;年龄7~69岁,其中21~50岁70例(63%)。伤后1h内就诊占56%,78例腹部穿刺,假阴性率5.0%。1.2伤因与伤情多为直接暴力所致,其中车祸伤48例,坠落伤26例,殴打     

美宝创面速愈贴促进腹部手术切口愈合的临床观察

目的：观察美宝创面速愈贴对腹部手术切口愈合的影响。方法：术后用美宝创面速愈贴及空白对照共48例临床的手术切口愈合情况和切口甲级愈合率进行观察。结果：美宝创面速愈贴组切口愈合时间明显较对照组缩短，且甲级愈合率明显高于对照组。结论：应用美宝创面速愈贴能加速腹部手术切口愈合，提高切口甲级愈合率。     

急诊手术治疗普外科疾病合并糖尿病55例临床分析

目的：探讨急诊手术治疗普外科疾病合并糖尿病患者的措施。方法：回顾性分析2009-10-2010-10急诊手术治疗普外科疾病合并糖尿病患者55例的临床资料。结果：入院时已明确糖尿病诊断的患者,经围手术期准备,均平稳度过围手术期,肠切除肠吻合术4例与急性化脓性阑尾炎6例术后并发切口感染,经对症处理后均痊愈出院。结论：急诊手术治疗普外科疾病合并糖尿病患者在围手术期应保持血糖稳定。     

胸伤为主的全身多发伤：国人创伤严重度评分方法探讨

对胸伤合并全身多发伤运用创伤评分指数ＲＴＳ、ＡＩＳ－ＩＳＳ、ＴＲＩＳＳ分析．伤员１４２例中存活１３７例，死亡５例，两组胸ＡＩＳ值近似，死亡组总ＩＳＳ较高，ＲＴＳ较低，说明总伤势和胸以外的严重合并伤对致死的作用较大．开放性胸伤６６例的合并伤以腹部伤较重，伴低血压休克，ＲＴＳ的降低主要因为首次血压（ｓＢＰ）下降；闭合性胸伤７６例的合并伤以头伤较重，伴意识障碍，ＲＴＳ的降低主要因为ＧＣＳ下降．全组的生存概率Ｐｓ＝０．９８±０．１，死亡例数与预测不同的原因是国人对创伤的反应性有别于国外．建议修正国人的创伤评分方法，首先应建立中国人的创伤数据库．     

开放性腹部损伤的诊治分析(附110例)

目的探讨急诊处理开放性腹部损伤的原则与救治生存率、并发症发生率的关系。方法110例开放性腹部损伤病人的临床资料分析。结果急诊时,采用腹壁伤道探查、诊断性腹腔穿刺、腹部X光透视及术中运用“系统、完整、仔细、勿躁、忌快”的剖腹探查原则,可减少多脏器损伤的漏诊及并发症。本组治愈率95％,并发症4．6％。结论通过上述措施,可提高开放性腹部损伤的救治生存率和减少并发症。     

70岁以上老年人胆石症102例外科治疗分析

目的探讨70岁以上老年人胆石症的临床特点及手术治疗方法。方法单纯胆囊切除72例,胆囊切开取石加造瘘2例,胆囊切除加胆总管探查加T管引流27例,胆总管空肠Roux-Y吻合1例。结果102例病人中,并发切口感染3例,胆泻1例;2例造瘘术后3个月再次手术治愈。并发症发生率为3·9%,治愈101例,死亡1例。结论老年人胆石症的外科治疗必须针对老年人胆道疾病的特点,选择合适的时机,精心做好围手术期处理,采取得当的术式,才能做到治愈率高,并发症少。     

Retrospective Analysis of Emergency Computed Tomography Imaging Utilization at an Academic Centre: An Analysis of Clinical Indications and Outcomes

PurposeTo explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting.MethodsA retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist.ResultsA total of 4556 CT scans were performed in the emergency department over a 1-year period. A total of 3.6% of all-comers to our emergency departments underwent CT scan as part of their investigation. There were 2107 head CTs (46%), 1296 (28%) abdominal CTs, 468 (10%) CTs of the chest, 408 (9%) CTs of the neck/spine, and 101 (2%) extremity CTs performed. The most common clinical indication for performing a CT head was focal neurological defect comprising 1534 (73%) of all CT heads. Twenty-four percent of abdominal CTs were for investigation of right lower quadrant pain, followed by flank pain (19%). Chest pain and shortness of breath were the most common indications for CTs of the chest (315 [75%]) with 10% of these examinations for this indication positive for pulmonary embolism. Trauma was the most common indication for neck CTs (296 [73%]) and extremities (70 [69%]). Nil acute was the most common final interpretation in all categories (79% CT heads, 75% neck CTs, 38% abdominal CTs, 43% chest CTs).ConclusionsNil acute was the most common diagnosis; however, serious clinical outcomes were identified 40% of the time. Cross-sectional imaging remains an integral tool for triage and diagnosis in this environment as the cost of missing a diagnosis in this setting has a great impact on patient care.     

Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data

ObjectiveWe compared appendiceal visualization on 2-mSv CT vs. conventional-dose CT (median 7 mSv) in adolescents and young adults and analyzed the undesirable clinical and diagnostic outcomes that followed appendiceal nonvisualization.Materials and MethodsA total of 3074 patients aged 15–44 years (mean ± standard deviation, 28 ± 9 years; 1672 female) from 20 hospitals were randomized to the 2-mSv CT or conventional-dose CT group (1535 vs. 1539) from December 2013 through August 2016. A total of 161 radiologists from 20 institutions prospectively rated appendiceal visualization (grade 0, not identified; grade 1, unsure or partly visualized; and grade 2, clearly and entirely visualized) and the presence of appendicitis in these patients. The final diagnosis was based on CT imaging and surgical, pathologic, and clinical findings. We analyzed undesirable clinical or diagnostic outcomes, such as negative appendectomy, perforated appendicitis, more extensive than simple appendectomy, delay in patient management, or incorrect CT diagnosis, which followed appendiceal nonvisualization (defined as grade 0 or 1) and compared the outcomes between the two groups.ResultsIn the 2-mSv CT and conventional-dose CT groups, appendiceal visualization was rated as grade 0 in 41 (2.7%) and 18 (1.2%) patients, respectively; grade 1 in 181 (11.8%) and 81 (5.3%) patients, respectively; and grade 2 in 1304 (85.0%) and 1421 (92.3%) patients, respectively (p < 0.001). Overall, undesirable outcomes were rare in both groups. Compared to the conventional-dose CT group, the 2-mSv CT group had slightly higher rates of perforated appendicitis (1.1% [17] vs. 0.5% [7], p = 0.06) and false-negative diagnoses (0.4% [6] vs. 0.0% [0], p = 0.01) following appendiceal nonvisualization. Otherwise, these two groups were comparable.ConclusionThe use of 2-mSv CT instead of conventional-dose CT impairs appendiceal visualization in more patients. However, appendiceal nonvisualization on 2-mSv CT rarely leads to undesirable clinical or diagnostic outcomes.     

体外循环心脏术后并发精神障碍60例临床分析

目的探讨成人体外循环手术以后发生精神症状的高危因素。方法对60例16岁以上的体外循环手术后发生精神症状的病人进行分析。结果主要表现有认知障碍、情感障碍、意志行为障碍及意识障碍。男女之间无明显差异,而在患者年龄、术前心功能、既往精神病史、监护室监护时间等方面精神病组和健康组间存在显著差异。结论成人体外循环手术后发生精神症状的高危因素有患者年龄、术前心功能、既往精神病史、心脏病史、监护室停留时间等,应高度重视和加强护理、观察。     

249例重型颅脑损伤救治策略分析

分析重型颅脑损伤２４９例病人和伤原因,探讨有效治疗策略,降低死亡率。方法分析各种损伤发生率,采用加强院前急救,术中脑保护与降颅压,术后专科监护和救治。结果本组伤因主要为交通伤１５４例,坠落伤３６例。损伤类型为硬膜血肿５２例,其次为硬膜外血肿４５例,多发性血肿４２例。存活１８６例,死亡率２５．３％。     

Prostate Imaging and Data Reporting System Version 2 as a Radiology Performance Metric: An Analysis of 18 Abdominal Radiologists

PurposeTo determine expected trained provider performance dispersion in Prostate Imaging and Data Reporting System version 2 (PI-RADS v2) positive predictive values (PPVs).MethodsThis single-center quality assurance retrospective cohort study evaluated 5,556 consecutive prostate MRIs performed on 4,593 patients. Studies were prospectively interpreted from October 8, 2016, to July 31, 2020, by 18 subspecialty-trained abdominal radiologists (1-22 years’ experience; median MRIs per radiologist: 232, first-to-third quartile range [Q1-Q3]: 128-440; 13 interpreted at least 30 MRIs with a reference standard). Maximum prospectively reported whole-gland PI-RADS v2 score was compared to post-MRI biopsy histopathology obtained within 2 years. The primary outcome was PPV of MRI by provider stratified by maximum whole-gland PI-RADS v2 score.ResultsMedian provider-level PPVs for the radiologists who interpreted ≥30 MRIs with a reference standard were PI-RADS 3 (22.1%; Q1-Q3: 10.0%-28.6%), PI-RADS 4 (49.2%; Q1-Q3: 41.4%-50.0%), PI-RADS 5 (81.8%; Q1-Q3: 77.1%-84.4%). Overall, the maximum whole-gland PI-RADS v2 score was PI-RADS 1 to 2 (34.6% [1,925]), PI-RADS 3 (8.5% [474]), PI-RADS 4 (21.0% [1,166]), PI-RADS 5 (18.3% [1,018]), no PI-RADS score (17.5% [973]). System-level (all providers) PPVs for maximum PI-RADS v2 scores were 20.0% (95% confidence interval [CI]: 15.7%-24.9%) for PI-RADS 3, 48.5% (95% CI: 44.8%-52.2%) for PI-RADS 4, and 80.1% for PI-RADS 5 (95% CI: 75.7%-83.9%).ConclusionSubspecialty-trained abdominal radiologists with a wide range of experience can obtain consistent positive predictive values for PI-RADS v2 scores of 3 to 5. These data can be used for quality assurance benchmarking.