腹部损伤再手术与预防探讨

目的 探讨腹部损伤手术后再次手术的原因及其预防措施.方法 回顾性分析2003年1月-2008年10月收治22例腹部损伤术后再手术患者的临床资料.结果 22例再手术的原因:术后出血5例次,胃肠瘘6例次,胆瘘3例次,胰瘘2例次,腹腔脓肿3例次,切口裂开4例次.术后1次再手术16例,2次手术4例,3次手术2例.再次手术治愈19例,死亡3例,病死率13.6%.结论 腹部损伤术中认真细致探查,彻底止血,术式合理,处理得当,引流通畅足预防或减少非计划性再手术的关键.     

腹腔镜阑尾切除术后非计划再手术16例原因分析

探讨腹腔镜阑尾切除术后非计划再手术的原因及防治措施。回顾性分析2017年1月—2019年1月收治的16例腹腔镜阑尾切除术后非计划再手术患者的临床资料。16例腹腔镜阑尾切除术后非计划再手术的原因为肠梗阻5例,腹腔脓肿4例,阑尾类癌2例,阑尾残端瘘、腹腔出血、阑尾残株炎、回盲部肿瘤、回肠憩室各1例,再次手术后痊愈出院。腹腔镜阑尾切除术出现肠梗阻、腹腔脓肿等并发症是非计划再手术的主要原因。术中彻底清除腹腔残余感染、仔细探查、彻底止血和规范的操作流程可降低阑尾炎术后非计划再手术的发生率。     

阑尾切除术后早期再手术16例分析

目的探讨阑尾切除术后再手术的原因及预防措施。方法对1986年1月至2005年1月收治的16例阑尾切除术后早期再手术的临床资料进行回顾性分析。结果本组再手术病例全部治愈。再次手术的术后并发症3例,其中粪瘘2例,腹腔残余脓肿并切口感染1例。获得随访12例,随访时间最长8个月,最短3个月,平均4.2个月未发现有其它并发症。结论正确诊断,规范手术操作,术中仔细的探查和正确处理常常可以避免或减少阑尾切除术后近期再手术。     

阑尾切除术后再手术31例分析

对３１例因阑尾切除术后再次手术的原因、手术方式和教训进行分析,再手术的原因有阑尾残株炎、切口疝、粘连性肠梗阻、出血、阑尾及升结肠肿瘤、腹腔脓肿、活动盲肠、粪瘘,卵巢囊肿扭转、腹腔异物等。根据不同的原因采用合理的手术方式。术后对２５例病人进行随访,结果２３人治愈,１例术后３个月死亡,１例２年后因胃癌死亡。     

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腹部外科术后近期再手术是指首次术后 14～ 2 1天内施行的再次手术[1] 。文献报告因首次手术的差错而再手术占近期再剖腹病例的 4 0 %左右[2 ] 。 1995年 1月至 2 0 0 0年12月本院共发生 32例腹部术后近期医源性再手术。现报道如下。1　资料与方法1.1　一般资料本组 32例 ,男 2 2例 ,女 10例。年龄 4～ 72岁 ,平均4 3 6岁。再手术距首次手术时间 1h至 2 1天 ,其中 1周内2 1例 (6 6 % )。1.2　再手术原因及处理方法(1)腹腔内出血 8例 (2 5 % ) ,再手术行血管结扎或缝扎止血 6例 ,脾切除术及肝动脉结扎术各 1例。 8例再手术距首次手术时间 1～…     

诊治失误致阑尾切除术后再手术33例临床分析

目的　探讨阑尾炎近期再手术的原因、手术方法及预防措施。方法　对我院 1989年12月至 2 0 0 2年 12月间收治的阑尾炎近期再手术 3 3例进行回顾性分析。结果　术前及术中误漏诊 17例 ,其中结肠肿瘤 8例 ,横结肠重复畸形及炎性肉芽肿各 2例 ,盲肠游动症及十二指肠升段狭窄各 1例。胃后壁穿孔、腹部卒中及急性胰腺炎各 1例并因病情发展而死亡。术中操作不当 7例。其中系膜血管出血、血肿破溃 ,网膜、阑尾残端及切口引流处皮下出血各 1例 ,残株炎 1例 ,腹腔遗留坏死组织及粪石 1例。术后并发症 9例 ,盆腔脓肿 ,阑尾残端粪瘘 ,腹壁切口疝及结核性腹壁窦道各 2例 ,肌间脓肿 1例。结论　正确诊断 ,充分准备 ,仔细操作 ,严密观察 ,及时处置 ,常能避免或减少阑尾炎近期再手术的发生。     

腹部外科术后近期非计划性再次手术10例临床分析

<正>腹部外科手术后1个月内进行的手术称为腹部手术后近期再次手术[1],分为计划性和非计划性再手术,笔者处理非计划性再手术10例,效果满意,报道如下。1临床资料1.1一般资料我院2014年3月收治腹部术后非计划性再手术患者10例,男3例,女7例;年龄23~67岁,平均年龄45岁。再手术时间为术后4 h~20 d。术后腹腔内出血3例,机械性肠梗阻3例,胆漏2例,胆总管梗阻2例(基层医院行腹腔镜胆囊     

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腹部外科再手术是一个非常复杂的问题 ,临床上并不少见。一般将初次手术后 1个月内再手术者称为近期再手术 ,超过 1个月者为晚期再手术。再手术一般都与前次手术密切相关 ,但也可以完全无关 ,后者较少见 ,在此不作讨论。腹部外科再手术一般包括以下几种情况 :(1)前次手术出现并发症 ,如腹腔脓肿、切口裂开等。 (2 )前次手术未达到预期疗效 ,如外伤病人首次手术探查遗漏病变。 (3)病情需要分阶段手术 ,如急诊左半结肠癌梗阻首次切除癌肿造瘘 ,二期闭瘘。 (4 )疾病复发 ,主要是各种恶性肿瘤的复发手术。1　前次手术出现并发症　　大多需急诊再…     

腹部手术后腹腔脓肿35例诊治体会

脓性腹膜炎或腹部手术后腹腔脓肿可以发生在腹腔任何部位,如不及时引流,死亡率较高。我院1988～1994年诊治35例术后腹腔脓肿,取得较好效果,现报道如下: 临床资料 一、一般资料 35例腹腔脓肿中;阑尾穿孔术后腹腔脓肿14例,胃十二指肠穿孔术后腹腔脓肿2例,外伤性肠破裂术后腹腔脓肿7例,坏死性胰腺炎术后脓肿3例,肠梗阻术后腹腔脓肿4例,伤寒肠穿孔术后腹腔脓肿3例,胆道术后脓肿2例。     

老年人腹腔镜胆囊切除术后近期再手术临床分析:附35例

目的 探讨老年人腹腔镜胆囊切除术(LC)后近期再手术的原因及防范措施.方法 回顾性分析1993年1月至2007年9月老年病人LC术后近期再手术的35例临床资料.结果 35例病人经再手术治疗后34例获痊愈,其中再手术后发生并发症11例.分别为切口感染2例、腹腔残余脓肿1例、肺部感染3例、应激性溃疡2例、胆管炎1例、下肢深静脉血栓形成2例,均予对症处理,1例于再次手术后第3天死于应激性溃疡.结论 重视病史询问、完善术前检查,严格选择适应证、规范手术操作、适时中转开腹以及针对老年病人的一些特殊措施是减少老年病人LC术后近期再手术的关键.     

损伤控制性手术治疗严重肝脏创伤(附32例回顾性分析)

目的探讨损伤控制性手术（DCS）治疗严重肝脏创伤的临床价值，以总结手术经验。方法回顾性分析1999年8月至2006年8月，采用DCS原则治疗32例严重肝脏创伤的手术资料和后续治疗的情况。结果32例病人均经损伤控制性手术治疗：SICU复苏后，所有病人均接受相应形式的再次确定性手术。治愈28例（87．5％），再次手术术后出现肝脓肿、胆瘘各1例（各为3．1％），经保守治疗痊愈；死亡4例（12．5％），死亡原因与手术无关。结论符合DCS指征的严重肝脏创伤的病人，应积极选择适宜的手术治疗方式，并应根据损伤的不同部位和程度，分次手术治疗。     

Unplanned reoperations for infection complications: a survey for quality control

BACKGROUND: Unplanned reoperation is perceived as a quality indicator for surgical procedures. However, there is a lack of data regarding the extent to which infections add to the reoperation rate. We studied the role of infection as an indication for unplanned reoperation. METHODS: The setting was a surgical department at an academic teaching hospital performing a spectrum of general, vascular, thoracic (lung), and transplant (kidney) procedures. Between January, 2003 and September, 2004, data on operations, unplanned reoperations, and complications were documented prospectively. Unplanned reoperation was defined as unexpected reoperation within 30 days of the primary procedure. Endpoints were the number of unplanned reoperations attributable to infection, the site of the infection, the type of the primary operation, and deaths. RESULTS: A total of 6,287 operations were performed during the study period. The rate of unplanned reoperations was 1.34% (84/6287), and 15 (17.9%) of these 84 patients had to undergo reoperation because of an infection. The primary operations in these cases were general surgical procedures in 11 patients, kidney transplant in two patients, and vascular surgery and lung resection in one patient each. Leakage of a gastrointestinal anastomosis was the predominant cause in the general surgical group (8/11). The most frequent initial procedure was colon resection (n = 4) followed by ileostomy closure (n = 2) and kidney transplant (n = 2). One unplanned reoperation had to be done after esophagectomy, pancreatoduodenectomy, pneumonectomy, incisional hernia repair, appendectomy, femoro-femoral bypass, and resection of a soft tissue tumor. The mortality rate after unplanned reoperation for infection was 20% (3/15), a significantly higher rate than in patients not having reoperation (p < 0.00001). Subgroup analysis did not show any significant difference in mortality according to whether the unplanned reoperation was indicated by infection, bleeding, or other reason (p = 0.28). Patients who required operation because of an infection stayed significantly longer in the intensive care unit (p = 0.018) and underwent more reoperations (p = 0.003) than those with other indications for reoperation. CONCLUSION: Infections add considerably to the rate of unplanned reoperation. The mortality rate is high, but not significantly different from that in patients having reoperation for other indications. A longer stay in the intensive care unit and a higher number of reoperations indicate a greater use of resources by these patients.     

Acute pancreatitis after surgical treatment of abdominal aortic aneurysm

INTRODUCTION: Acute pancreatitis after surgical treatment of non ruptured aneurysm of abdominal aorta is a rare complication, considered to be due to pancreatic ischemia or peroperative trauma of pancreas. The aim of this study is to describe 4 new cases of this complication and to discuss its etiology. PATIENTS AND METHODS: From January 1995 to November 2000, 365 patients underwent elective surgery for a non ruptured abdominal aorta aneurysm. Four (1.1%) men, aged 66 to 79 years and operated for an aneurysm which diameter ranged from 60 to 77 mm, developed postoperative acute pancreatitis. The abdominal approach was a midline incision in 3 cases and a retroperitoneal lombotomy in one case. Superior pole of the aneurysm always adjoined or involved the right renal artery. The aortic clamping was supra-renal in 3 cases and celiac in one case. Diagnosis of acute pancreatitis was established at days 2, 4, 12, and 23 after surgery on abdominal computed tomography in 3 cases and at reoperation in one case. RESULTS: Three patients died, including 2 from early multiple organ failure and one peroperatively during surgical attempt to treat a prostheto-digestive fistula. One patient was alive and asymptomatic with a 2-years follow-up. CONCLUSION: Acute pancreatitis is a rare and serious complication after surgical treatment of abdominal aorta aneurysm. Its diagnosis is often delayed. The main etiological factor of this complication could be trauma of pancreas during supra-renal clamping through a midline incision.     

胰腺损伤的诊断与治疗

目的：进一步提高胰腺损伤的诊断和治疗水平。方法：回顾性分析近10年收治的胰腺损伤43例的临床资料。结果：单纯胰腺损伤3例（7％）,40例（93％）为多发伤或多脏器伤,39例（90．7％）入院时已有明显的腹腔内大出血休克或空腔脏器穿孔的腹膜炎体征。术前确诊仅4例（9．3％）,术中漏诊2例;术后死亡4例（9．3％）,非胰腺损伤死亡3例,因漏诊再次手术死于多脏器功能衰竭1例;胰瘘5例中漏诊所致2例。结论：病史和查体是诊断胰腺损伤的基础,剖腹探查是诊断胰腺损伤的首要可靠方法;早期诊断,避免漏诊,合理的术式,是减少并发症和降低病死率的关键。     

Clinical management of abdominal trauma

Objective： To improve the prognosis of patients with abdominal trauma.
Methods： Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years （ranging from 3-82 years）. All abdominal traumas consisted of closed traumas （360 cases, 86.7%） and open traumas （55 cases, 13.3%）.Results： A total of 407 cases （98.1%） were fully recov- ered from trauma and the other 8 cases （1.9%） died of mul- tiple injuries. The mean injury severity score （ISS） of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds （6 cases）, pancreatic fistula （2 cases） and intestinal fistula （1 case）. All these postoperative complications were cured by the conservative treatment. Conclusion： Careful case history inquisition and physical examination are the basic methods to diagnose abdominal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.     

Thirty-day unplanned reoperations of thoracic spine surgery: 10 years of data from a single center with 3242 patients

BACKGROUND CONTEXTUnplanned reoperation is a useful quality indicator for spine surgery. However, the rates of a 30-day unplanned reoperation in patients undergoing thoracic spinal surgery are not well established.PURPOSETo assess the rates, reasons, and risk factors of 30-day unplanned reoperations for thoracic spine surgeries in a single center study.STUDY DESIGNA retrospective observational study.PATIENT SAMPLEA total of 3242 patients who underwent thoracic spinal surgery at our institution in the past decade were included.OUTCOME MEASURESThe incidence, chief reasons, and risk factors for unplanned reoperations within 30 days after thoracic spinal surgery.METHODSWe retrospectively analyzed the data of all patients who underwent thoracic spinal surgery between January 2012 and December 2021. Statistical methods, including univariate and multivariate analyses, were performed to assess the incidence, reasons, and risk factors for thoracic degenerative diseases, spinal tumors, kyphosis deformity, and spinal trauma.RESULTSOf the 3242 patients who underwent thoracic spinal surgery, 107 (3.30%) required unplanned reoperations within 30 days due to epidural hematoma (1.17%), wound complications (0.80%), implant complications (0.43%), inadequate decompression (0.25%), and other causes (0.65%). Patients with degenerative disease (3.88%), spinal tumor (2.98%), and kyphosis deformity (3.33%) had significantly higher incidences of reoperation than those with spinal trauma (1.47%). Unplanned reoperations were classified as hyperacute (30.84%), acute (31.76%), and subacute (37.38%). After univariate analysis, several factors were associated with unplanned reoperation in the 4 cohorts of thoracic spine diseases (p<.05). Multivariate logistic regression analysis revealed that upper thoracic spine surgery (p=.001), concomitant dekyphosis (p=.027), and longer activated partial thromboplastin time (p=.025) were risk factors of unplanned reoperation for thoracic degenerative disease. Whereas American Society of Anesthesiologists (ASA) grade III (p=.015), combined approach (p=.016), and operation time longer than 420 min (p=.042) for spinal tumor, and similar ankylosing spondylitis (p=.023) and operation time longer than 340 min (p=.041) were risk factors of unplanned reoperation for kyphosis deformity.CONCLUSIONSThe unplanned reoperation rate for thoracic spine surgery was 3.30%, with epidural hematoma and wound complications being the most common reasons. However, upper thoracic spine surgery, concomitant dekyphosis, underlying coagulation disorder, longer operation time, higher ASA grade, and comorbidities of ankylosing spondylitis led to an increased risk of unplanned reoperation within 30 days of thoracic spine surgery.     

胰十二指肠切除术后腹腔内迟发性出血的原因与处理

目的：探讨胰十二指肠切除术后迟发性腹腔内出血的原因与处理方法。
方法:回顾性分析168例施行胰十二指肠切除术的患者中术后腹腔内出血的情况。
结果:168例患者中有38例出现腹腔内迟发性出血,发生率为22.6%（38/168）;因大出血而再次手术止血11例,发生率6.5%（11/168）;再手术的病死率27.3%（3/11）;出血的主要原因是合并胰瘘或腹腔感染。
结论:胰十二指肠切除术后腹腔内出血与胰瘘或腹腔感染密切相关。完善围手术期的处理,预防与及时发现、积极处理胰瘘和腹腔感染可以减少腹腔内迟发性出血的发生。

     

Damage control surgery for severe thoracic and abdominal injuries

OBJECTIVE: To investigate the application of damage control surgery in treatment of patients with severe thoracic and abdominal injuries. METHODS: A retrospective study was done on 37 patients with severe thoracic and abdominal injuries who underwent damage control surgery from January 2000 to October 2006 in our department. There were 8 cases of polytrauma (with thoracic injury most commonly seen), 21 of polytrauma (with abdominal injury most commonly seen) and 8 of single abdominal trauma. Main organ damage included smashed hepatic injuries in 17 cases, posterior hepatic veins injuries in 8,pancreaticoduodenal injuries in 7, epidural or subdural hemorrhage in 4, contusion and laceration of brain in 5, severe lung and bronchus injuries in 4, pelvis and one smashed lower limb wound in 3 and pelvic fractures and retroperitoneal hemorrhage in 6. Injury severity score (ISS) was 28-45 scores (38.4 scores on average), abbreviated injury scale (AIS) > or = 4.13. The patients underwent arteriography and arterial embolization including arteria hepatica embolization in 4 patients, arteria renalis embolization in 2 and pelvic arteria retroperitoneal embolization in 7. Once abbreviated operation finished, the patients were sent to ICU for resuscitation. Twenty-four cases underwent definitive operation within 48 hours after initial operation, 5 underwent definitive operation within 72 hours after initial operation, 2 cases underwent definitive operation postponed to 96 hours after initial operation for secondary operation to control bleeding because of abdominal cavity hemorrhea. Two cases underwent urgent laparotomy and decompression because of abdominal compartment syndrome and 2 cases underwent secondary operation because of intestinal fistulae (1 case of small intestinal fistula and 1 colon fistula) and gangrene of gallbladder. RESULTS: A total of 28 patients survived, with a survival rate of 75.68%, and 9 died (4 died within 24 hours and 5 died 3-9 days after injury). The trauma deaths at the early stage were caused by severe primary injuries resulting in failure of respiration and circulation, while mortality at the later stage was caused by multiple organ failure. CONCLUSIONS: Damage control surgery is important for the treatment against severe thoracic and abdominal injuries. It is suggested that the surgeon should select the reasonable auxiliary examination before operation, and take the proper time to perform damage control and definitive surgery.     

加速康复外科在腹腔镜胰十二指肠切除围手术期的渐进式应用

目的 探讨加速康复外科(ERAS)在腹腔镜胰十二指肠切除术(LPD)围手术期渐进式应用的临床效果.方法 前瞻性分析西安交通大学附属咸阳市中心医院肝胆外科2018年3月至2021年3月拟行LPD的112例患者临床资料.采用渐进式推行ERAS:所有病例经术前按标准严格排查,术前及术中均采用ERAS所要求的处理措施.手术过程...     

胰腺损伤的诊断和治疗探讨

目的探讨胰腺损伤的诊断和治疗方法。方法对我院自1994年3月至2004年3月收治的24例胰腺损伤进行回顾性分析。结果本组24例中治愈22例,死亡2例。术后有17例发生并发症(58.3%),其中胰瘘11例,胰腺假性囊肿2例,反复发作慢性胰腺炎1例和切口感染3例。结论根据受伤部位、腹痛、呕吐等临床症状和腹部压痛反跳痛等腹膜炎体征应考虑胰腺损伤。淀粉酶检测和影像学检查有助于诊断,手术力求简单有效。