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十二指肠损伤是一种常合并周围脏器损伤的严重内伤,约占腹腔脏器损伤的3%~5%[1].十二指肠绝大部分位于腹膜后,位置较深,毗邻关系复杂,生理学上极为重要,一旦损伤术前确诊困难,即使剖腹探查,漏诊率也较高[2],处理上也常较其他脏器的损伤为难.笔者2001年1月- 2011年1月治疗10例外伤性十二指肠损伤患者.现报告如下.
1临床资料
1.1一般资料
本组男7例,女3例;年龄23 ~57岁,平均40岁.致伤原因:高处坠落伤4例,交通伤4例,刀刺伤2例.闭合性损伤8例,开放性损伤2例.受伤至就诊时间0.5~15 h.根据Lucas十二指肠损伤分级:Ⅰ级,十二指肠挫伤,表现为十二指肠壁血肿,但无穿孔和胰腺损伤,本组2例;Ⅱ级,十二指肠破裂,无胰腺损伤,本组6例;Ⅲ级,十二指肠损伤伴轻度胰腺挫裂伤,本组2例.本组球部损伤5例,降部损伤4例,水平部损伤1例.伴后腹膜血肿5例,合并肝破裂伤4例,右肾挫裂伤1例,胰腺损伤2例,脾脏破裂伤1例,胃损伤2例. 相似文献
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十二指肠损伤常合并多器官损伤 ,早期诊断和处理比较棘手 ,手术并发症多 ,病死率高。为此 ,我们总结十二指肠损伤 10例的诊治经验以供同行参考。1 临床资料1 1 一般情况 10例中 ,男 8例 ,女 2例 ;年龄 2 0~ 4 2岁 ,平均 31岁。车祸伤 5例 ,锐器伤 2例 ,撞击伤 3例。损伤部位、程度及合并伤情况按Moore损伤分级[1] :Ⅰ级 2例 ,Ⅱ级 3例 ,Ⅲ级 4例 ,Ⅳ级 1例。除单纯性十二指肠破裂 2例外 ,余均为多发伤 ,其中颅脑损伤 2例 ,胸部伤 2例 ,腹内脏器损伤 13例 (肝、脾破裂各 1例 ,腹膜后血肿 8例 ,小肠破裂 3例 )。合并创伤性休克 8例… 相似文献
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十二指肠损伤机会不多。仅占腹部外伤的3%~5%,但其死亡率却可达10%~24%[2]。如何正确处理十二指肠损伤,对挽救因外伤而致十二指肠破裂患者的生命,具有至关重要的作用,自1985年9月~1996年12月共收治外伤性十二指肠破裂患者6例,其中3例试行十二指肠憩室化手术,初步获得满意效果,兹介绍如下。1临床资料与方法1.1临床资料外伤性十二指肠破裂6例,均为男性,平均年龄21.8岁。上述患者符合下列条件:有外伤史、术中探查确为十二指肠破裂;多为十二指肠降部及横部损伤,有食物、胆汁、胰液污染腹腔。1.2手术方法及术式在6例外伤性… 相似文献
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我院 1984年 8月~ 1998年 8月收治腹部创伤 12 16例 ,其中十二指肠损伤2 6例 ,占 2 .14% ,均经手术治疗。现就十二指肠损伤的诊断分类及术式选择探讨如下。临 床 资 料一、一般资料本组 2 6例 ,男 2 2例 ,女 4例 ;年龄12~ 6 4岁 ,平均 2 9.75岁。闭合伤 2 4例(多为撞击或挤压伤 ) ;开放伤 (刀刺伤 ) 2例。合并其他脏器损伤 2 5例次 ;6例伴有休克。术前明确诊断 2例 ,术前疑为十二指肠损伤 2例。术中确诊 2 5例 ,漏诊 1例。损伤程度分类参照Lucas[1 ] 的标准稍加变动。见表 1。结 果1.十二指肠修补术和 (或 )腹腔引流术共 6例 ,… 相似文献
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目的探讨超声检查对高原地区腹腔脏器损伤的诊断价值。方法对86例腹腔脏器损伤者行腹部常规扫查,腰背部扫查,盆腔超声检查。结果超声检查结果与手术诊断对照。实质脏器损伤符合率占89.1%,宫外孕及子宫损伤符合率占68.7%,空腔脏器损伤符合率占50.0%。结论超声检查对实质性脏器破裂有较高的诊断价值,对空腔脏器破裂有一定的应用价值。超声检查能提供可靠诊断依据,为西藏地区腹脏器破裂的首选检查方法。 相似文献
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One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care. 相似文献
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V. A. Serezhenkov I. A. Moroz G. A. Klevezal A. F. Vanin 《Applied radiation and isotopes》1996,47(11-12)
ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method. 相似文献
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Analysis of the results of the international comparison of activity measurements of a solution of Fe
The results of an international comparison of activity measurements of a solution of 55Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a 55Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.
The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison. 相似文献
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D Gasparini 《La Radiologia medica》1987,73(4):304-309
A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood. 相似文献
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目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率. 相似文献