肾脏损伤的CT诊断

肾脏损伤在闭合性腹部创伤中是比较常见的，仅次于肝脾的损伤。CT评价腹部钝性伤已得到广泛地承认，它具有很高的敏感性与特异性，能准确而迅速地估计所有腹内脏器的情况，尤其对肝脾肾损伤的明确诊断与损伤的范围确定。为外科医师治疗提供了重要的依据。笔者单位在十几年中共有48例肾损伤的病例，现做回顾性分析与总结。     

514例腹部严重多脏器伤分析

目的 提高早期多发伤伴腹部严重多脏器的诊断和手术治疗水平。方法 ７年多收治严重腹部多脏器伤５１４例,男４２１例,女９３例。伤因主要为效能伤、高处坠落伤、斗殴伤等。ＩＳＳ≥１６,最高６６,平均３１．５。闭合伤４２７例,开放伤８７例剖腹手术４３９例,腹内主要脏器损伤依次是脾、肝、肾、胃、大小肠、结肠、直肠等。结果 存活４７３例,入院时血压为零被抢救成功７２例,由于首次手术处置不当或遗漏损伤脏器再次手术     

腹部伤的诊断和救治

腹部战伤中绝大多数为开放伤，95％会击伤腹内脏器，造成内出血或腹膜炎，引起失血性或中毒性休克。战时闭会伤，如车祸、坦克撞伤等较少见。1腹部伤的诊断1．1临床表现主要为腹痛，见于实质脏器伤后出血，空腔脏器伤破裂，血液及胃肠内液体流入腹腔。腹部呈持续性疼痛。投射物出入经过部位常是脏器损伤的部位，因而该部位疼痛亦更重。如伴有颅脑伤昏迷、脊柱脊髓伤时，伤员虽无主诉腹痛，也木应忽视对腹部的检查。腹内脏器损伤常伴有恶心与呕吐，有时伤后早期可能无呕吐，但也不应忽视；只有腹壁伤而无腹内脏器伤者，此类伤员多不伴呕吐。1…     

影像学诊断在肾脏损伤的应用价值

肾脏损伤是泌尿系统最常见的外伤，平战时均较为多见，约占腹部创伤患者8％～10％，主要见于交通事故、体育运动及刀、枪伤等。腹部钝性伤约占腹部创伤的80％～90％，穿透伤约占10％～20％。严重的肾脏损伤常常合并其他器官的损伤，80％的穿透伤、75％的钝性闭合伤合并多器官损伤。绝大多数肾脏损伤为轻度损伤。肾脏损伤的诊断     

腹腔镜在腹部闭合性损伤中的应用

目的分析腹腔镜诊断与治疗腹部闭合伤的临床价值。方法2007年8月～2009年6月，我院对87例腹部闭合伤患者使用腹腔镜诊断，并根据镜检结果决定镜下治疗或中转开腹手术。结果87例腹部闭合伤均于镜下作出正确诊断，33例于镜下治疗，19例无需治疗性处理，35例中转开腹手术。5例术后有并发症，全组均治愈出院。结论腹腔镜诊治腹部闭合伤具有创伤小、安全可靠、诊断率高、能有效降低阴性剖腹探查率等优点，适用于大部分腹部闭合伤的病例。     

68例腹部交通事故伤的特点及救治

目的 探讨交通事故腹部伤的特点及救治。方法 回顾性分析68例交通事故腹部伤的临床资料。结果 68例均为闭合伤,共涉及101个腹腔脏器损伤,合并腹腔以外脏器严重伤22例,休克28例。腹穿66例,阳性61例。阳性率92．4％。手术治疗62例,非手术治疗6例。治愈61例,死亡7例。结论 交通事故腹部伤的诊断主要依靠病史、体格检查、诊断性腹腔穿刺。及时作出是否剖腹的判断是救治成功的关键。     

多发伤中腹部伤94例救治体会

我科于 1 989年 2月～ 1 998年 6月共收治涉及腹部脏器伤的多发伤 94例 ,报告如下。1　临床资料1 1　一般资料　男 78例 ,女 1 6例。年龄 8～ 62岁 ,其中2 0～ 50岁 62例 ,占 66 8%。伤后 2ｈ内入院者 76%。就诊时有休克表现者 66例 ,占 70 2 % ,其中血压为 0者 1 3例。1 2　受伤原因　车祸伤 63例 ,坠落伤 1 6例 ,挤压伤 1 1例 ,其它伤 4例。1 3　损伤情况　本组均为多发伤 ,除腹部损伤外还同时并存颅脑、胸部、骨盆、脊柱、骨关节等 1处或多处损伤。经手术证实 94例共伤腹内脏器 1 62个 ,最多腹内 6个脏器受伤。受伤脏器列前 3位者是…     

道路交通事故腹部伤的急诊处理(附127例分析)

目的探讨交通事故腹部伤的优化急诊处理方法。方法回顾性分析了127例交通事故腹部伤患者的急诊处理资料。结果127例伤者均行手术治疗,其中闭合伤124例均行腹腔穿刺。本组治愈113例,死亡14例,无1例漏诊、误诊。结论对交通事故腹部伤患者的急诊处理应注意如下几点：（1）详尽的体检和病史采集;（2）对休克、脊柱损伤及重型颅脑损伤者应警惕腹内伤的可能;（3）慎重选择辅助检查,对疑有腹内伤者首选腹腔穿刺。     

外伤性脾损伤的经导管动脉栓塞

在腹部钝性伤中,脾脏创伤居腹内脏器损伤之首,脾损伤后的死亡率为５％～２５％,伴创伤性休克为５０％～６０％,早期死亡多为严重的复合伤及出血性休克,其中６６％是死于大出血及急性肾功能衰竭［１］。我院自１９９５年以来共行经导管动脉栓塞（ＴＡＥ）治疗脾损伤１...     

腹部穿透伤伴网膜、肠管脱出的治疗方法探讨

目的探讨腹部穿透伤网膜、肠管脱出的诊治方法。方法回顾性分析近10年来收治的86例网膜、肠管脱出且血流动力学稳定的腹部穿透伤病人的临床资料。按首次治疗方法分为3组：有剖腹指征立即行剖腹探查44例(组Ⅰ);无剖腹指征行保守治疗16例(组Ⅱ);腹腔镜诊治26例(组Ⅲ)。结果组Ⅰ发现脏器损伤36例,阴性剖腹8例;组Ⅱ保守治疗成功12例,中转剖腹4例,但其中1例为阴性剖腹;组Ⅲ腹腔镜探查阴性6例,腹腔镜手术处理损伤13例,中转剖腹7例。全组无腹内脏器损伤的比率为31．40％(27／86)。结论腹部穿透伤合并网膜、肠管脱出并不意味着腹内脏器损伤,剖腹探查会出现较高的阴性探查率,选择性保守治疗有一定的风险,采用腹腔镜处理是一种较好的诊治方法。     

Emergency excretory urography in blunt abdominal trauma

In a prospective study the authors correlated the degree of hematuria and of blunt abdominal trauma with the results of emergency excretory urography. Urograms were obtained for 37 patients who presented with blunt abdominal trauma, no gross hematuria and at least five erythrocytes per high-power field (hpf) on microscopic urinalysis. Microscopic hematuria was defined as an erythrocyte count of more than 5 and fewer than 50 per hpf. Major trauma was defined as shock (systolic blood pressure of less than 90 mm Hg), fracture of the lumbar spine, the pelvis or the lower ribs, ecchymosis in the flank or acute abdominal injury. Contusions and small subcapsular hematomas were defined as nonsignificant renal injuries; all other renal injuries were defined as significant. Of 17 patients with minor blunt abdominal trauma 14 had fewer than 50 erythrocytes per hpf; none of these had a significant renal injury, whereas 1 of the 3 with more than 50 erythrocytes per hpf did have a significant injury. Of 20 patients with major trauma 5 had a significant renal injury. The authors conclude that microscopic hematuria associated with blunt abdominal trauma but without shock or major nongenitourinary injury does not warrant routine excretory urography.     

Blunt abdominal trauma in soccer causing duodenal rupture: case report and review

A case of blunt abdominal trauma in soccer is reported A forward player sustained a rupture of the distal duodenum in a collision with the opposing team's goalkeeper. The injured player had abdominal pain radiating to the back and a sustained high pulse but no sign of shock or peritonitis. The x-ray diagnosis was followed by emergency surgery and uneventful recovery. Injuries from blunt abdominal trauma occur rarely in sports. In soccer, the most frequently injury from this type of trauma is abdominal wall contusion, followed by injuries to the kidneys and spleen. However, death has also been reported in soccer. Athletes sustaining blunt trauma to the upper abdomen should be carefully monitored due to the risk of possible severe intra-abdominal injuries.     

The significance of hematuria in children after blunt abdominal trauma

The clinical significance of hematuria in children who sustain blunt abdominal trauma continues to be debated, as do the criteria for diagnostic imaging in this population. Previous reports have discussed the usefulness of certain clinical predictors of renal injury, such as the amount of hematuria present, the presence of shock or of head injury, and the presence or absence of symptoms or findings on physical examination. To assess the value of such predictors of renal injury in children with posttraumatic hematuria, we reviewed and analyzed the medical records and abdominal CT examinations of 256 children with blunt abdominal trauma. One hundred six children (41%) had hematuria. Thirty-five patients (14%) had renal injury that could be diagnosed by using CT. Nine of these had clinically significant injuries according to our criteria. We found a direct relationship between the amount of hematuria and the severity of renal injury. Hypotension at presentation occurred in 38 patients and was an insensitive predictor of renal injury. The combination of hypotension and hematuria was no more sensitive than hematuria alone in predicting renal injury. Sixty patients had concomitant craniofacial injuries. This subgroup had the same prevalence of hematuria and renal injury as the group that did not have head injuries. There were no clinically occult renal injuries in the study population. Furthermore, we found that no normotensive child with fewer than 50 RBCs per high-power field had a significant renal injury, and conversely, all children with significant renal injuries had either large amounts of hematuria or shock.     

Focused abdominal US in patients with trauma

PURPOSE: To evaluate the accuracy of focused abdominal ultrasonography (US) in detecting abdominal injuries that require in-hospital patient treatment in the setting of blunt abdominal trauma. MATERIALS AND METHODS: One thousand ninety patients with blunt abdominal trauma were assessed with focused abdominal US within 30 minutes of arrival at the hospital. Focused abdominal US results were positive if intra- or retroperitoneal fluid was detected. Patients with negative US results and no other major injuries were observed in the emergency department for 12 hours before discharge. Patients who deteriorated clinically after negative initial US underwent repeat US and/or emergency abdominopelvic computed tomography (CT). Patients with positive or indeterminate US results underwent emergency abdominopelvic CT. RESULTS: Nine hundred seventy-four (89%) patients had negative focused abdominal US results; eight of these underwent CT. Sixty-six (6%) had positive US results. Four (0.4%) had false-negative and 19 (1.7%) had false-positive US results. Twenty-seven (2.5%) had indeterminate US results; of these, five (18.5%) had positive CT results. One hundred twenty-four (11.4%) required emergency CT. After indeterminate cases were excluded, focused abdominal US had 94% sensitivity, 98% specificity, 78% positive predictive value, 100% negative predictive value, and 95% accuracy. CONCLUSION: Focused abdominal US has a high negative predictive value for major abdominal injury in patients with blunt abdominal trauma.     

Visceral injury without hemoperitoneum: A limitation of screening abdominal sonography for trauma

Abdominal sonography for the detection of hemoperitoneum has become increasingly popular as a screening test for visceral injury after blunt trauma. The purpose of this study was to determine the frequency, severity, and clinical significance (outcome) of abdominal organ injuries that occur without hemoperitoneum on the initial evaluation of blunt abdominal trauma patients.During a 12-month period, 3392 blunt trauma patients were admitted to our center. Sonographic studies were performed as an initial screening evaluation to determine the presence of hemoperitoneum in 772 (22.7%) of these patients. Abdominal visceral injuries were verified by computed tomography (CT) or surgery in 196 (5.8%) of all blunt trauma admissions. Sonography, CT, and operative findings were reviewed to determine the presence or absence of hemoperitoneum in patients with abdominal injury. Patients with abdominal visceral injury without hemoperitoneum were further analyzed to identify the type of injury and the management required.A total of 246 abdominal injuries were identified in 196 patients. Fifty (26%) patients with abdominal visceral injuries diagnosed by admission CT scan had no evidence of hemoperitoneum. Admission sonography performed in 15 (30%) of these 50 patients also showed no evidence of hemoperitoneum. Visceral injuries detected by CT in the patients without hemoperitoneum included 22 of 100 splenic injuries (22%), 18 of 91 hepatic injuries (20%), 12 of 26 renal injuries (46%), and 1 of 9 mesenteric injuries (11%). Surgery was required to manage injuries in 10 of these patients.Up to 26% of blunt trauma patients with abdominal visceral injuries do not have associated hemoperitoneum identified on admission abdominal CT or sonography. Dependence on hemoperitoneum as the sole criterion of abdominal visceral injury after blunt trauma will result in falsely negative examinations and will miss potentially significant injuries.     

Screening US for blunt abdominal trauma: objective predictors of false-negative findings and missed injuries

PURPOSE: To determine the risk for missed injury in patients with blunt abdominal trauma and negative findings at screening ultrasonography (US) and with coexistent hematuria or fracture of the sixth through 12th ribs, lumbar spine, or pelvis. MATERIALS AND METHODS: From a database of 4,000 patients screened with US for blunt abdominal trauma at a level 1 trauma center, the 3,679 patients with negative US findings were retrospectively classified by consensus of two authors into high-risk (n = 494) and low-risk (n = 3,185) groups based on the presence of hypothetical predictors of missed injury: hematuria (n = 96) or fracture of the sixth through 12th ribs (n = 216), lumbar spine (n = 105), or pelvis (n = 174). Outcome in each patient was determined by the same two authors consensually after retrospective review of the trauma registry and all radiologic, surgical, and autopsy reports. The risk for missed abdominal injury was determined for each patient risk group and for each hypothetical predictor. Risks were statistically compared by using the Pearson chi2, Fisher exact, or Fisher-Freeman-Halton exact test, depending on expected frequencies. RESULTS: High-risk patients were 24 times more likely to have abdominal injuries after negative US findings (30 [6.1%] of 494) than were low-risk patients (eight [0.25%] of 3,185) (P <.001). Among high-risk patients, the absolute risks for missed abdominal injury associated with specific predictors were 15.6% (15 of 96 patients) for hematuria, 6.0% (13 of 216) for lower rib fractures, 7.6% (eight of 105) for lumbar spine fractures, and 5.2% (nine of 174) for pelvic fractures. Each of these risks was significantly higher for patients in the high-risk group than for those in the low-risk group (P <.001). CONCLUSION: Hematuria and fracture of the lower ribs, lumbar spine, or pelvis are objective predictors of missed abdominal injury in patients with blunt abdominal trauma and negative US findings, and such patients may benefit from additional screening with computed tomography.     

腹部创伤死亡危险因素分析

目的探讨腹部创伤患者的主要死亡原因,为提高救治成功率提供依据。方法回顾性分析我院2003年1月～2007年12月收治的腹部创伤病例,分组对比死亡组与存活组在年龄、性别、受伤到急诊就诊时间、受伤主要机制、开放或闭合性损伤、受累器官数目、检查阳性率、平均出血量、院前休克例数、损伤严重程度、手术方法等方面的差异。结果与存活组患者比较,死亡组患者在交通事故受伤比例高（P〈0．001）、腹外器官损伤数多（P〈0．001）、平均出血量多（P〈0．01）、院前休克例数多（P〈0．001）、损伤严重程度高。结论受伤机制、受累器官数目、休克、损伤严重程度、手术方法的选择等都是腹部创伤死亡危险因素。     

The role of follow-up imaging in paediatric blunt abdominal trauma

AIM: To assess the role of follow-up imaging in paediatric blunt abdominal trauma. METHOD: All children who underwent CT scanning of their abdomen at our institution following acute blunt injury between January 1997 and December 2000 were included in the study. Case notes where researched for details regarding mechanism of injury, initial clinical presentation, acute management, complications and follow-up until discharge. Reports of imaging investigations were retrieved from the RIS database. RESULTS: In the study period 75 children underwent CT scanning of their abdomen as a primary investigation for acute blunt abdominal trauma. Of these, 12 were normal, 52 showed evidence of intra-abdominal organ injury and 11 showed findings other than abdominal organ injury. Of the 52 children that sustained intra-abdominal organ injury, 48 (92 percent) were treated conservatively. 4 (8 percent) underwent emergency surgery, 3 for bowel injury and 1 for renal trauma. Of the 48 that were treated conservatively, 9 had a complicated clinical course with 7 showing complications on follow-up imaging. The remaining 39 children had an uneventful clinical course with follow-up imaging by CT or US in 34. None showed complications that required a change in management. CONCLUSION: In our series, follow-up imaging did not contribute to further management in children with an uncomplicated clinical course following blunt abdominal trauma.     

Post traumatic arterial occlusive mesenteric ischemia: a rare case report

Mesenteric ischemia is an uncommon condition with very high mortality rates characterized by inadequate blood supply, inflammatory injury, and subsequent necrosis of the bowel wall. Acute arterial mesenteric ischemia is usually caused by cardiac emboli, atherosclerotic vascular disease, aortic aneurysm, or dissection. We report a case of a 60-year-old male who presented to the accident and emergency department complaining of abdominal pain following blunt abdominal trauma. An urgent contrast enhanced computed tomography scan demonstrated superior mesenteric artery thrombosis with ischemic small bowel. Surgical intervention was carried out with resection of the necrotic bowel followed by anastomosis. Acute occlusive mesenteric ischemia needs to be considered in cases of blunt trauma presenting with abdominal pain. Proper early diagnosis and management is essential as it carries a high risk of morbidity and mortality.     

Prospective evaluation of handheld ultrasound in the diagnosis of blunt abdominal trauma

OBJECTIVES: To evaluate the Sonosite 180 handheld ultrasound in the diagnosis of haemoperitoneum in blunt abdominal trauma. METHODS: Trauma ultrasound using the Focused Assessment with Sonar for Trauma (FAST) technique was performed using the Sonosite 180 handheld ultrasound during the primary survey of adult patients triaged to the resuscitation room with multiple trauma or suspected abdominal injury. The ultrasound findings were compared against the investigation of choice of the attending surgeon/accident & emergency physician--CT, DPL, laparotomy or clinical observation. RESULTS: 50 patients who had sustained blunt abdominal trauma were evaluated using FAST. Satisfactory images were obtained in 96%. There were 5 true positive scans confirmed by CT, DPL or laparotomy. There were no false negative or false investigations. The sensitivity and specificity of handheld FAST was 100%. CONCLUSIONS: Handheld ultrasound using the Sonosite 180 system can be successfully used by appropriately trained doctors as the primary investigation in the acute evaluation of blunt abdominal trauma.