腹腔穿刺术在急腹症中的应用体会

目的：总结腹腔穿刺术在急腹症中的应用价值。方法：统计242例急腹症病人腹腔穿刺的临床资料。结果：腹穿阳性率92．6％（224／242），阴性率7．4％（18／242），假阳性率6．3％（14／224），假阴性率38．8％（7／18）。结论：腹腔穿刺术简便，易行，对急腹症的诊断有重要意义。     

Peritoneal Tap and Lavage in Patients with Blunt Abdominal Trauma: Their Contribution to Surgical Decisions

In a study of 51 patients with a history of blunt abdominal trauma, peritoneal tap and lavage made a positive contribution to the diagnostic process in 15 cases. Thirteen patients had early definitive operation on the basis of tap and lavage evidence which overruled the clinical evaluation, and two patients were managed conservatively when a negative tap and lavage contradicted the clinical decision.     

腹腔穿刺灌洗在急腹症中的应用

目的评价腹腔穿刺灌洗对急腹症诊断的有效性及安全性。方法在2005-07~2009-08间,对106例急腹症患者行腹腔穿刺灌洗。引流穿刺物分别以腹腔穿刺液常规检查+淀粉酶测定及肉眼观察。结果阳性病例77例,阳性率72.6%;阴性病例29例,阴性率27.4%。结论腹腔穿刺灌洗,具有安全、易行,适合临床推广。     

闭合性腹部损伤延迟诊断6例分析

目的探讨闭合性腹部损伤延迟诊断的原因。方法回顾性分析晋城煤业集团总医院2008-01～2011-12年期间收治的6例闭合性腹部损伤延迟诊断的临床资料。结果 6例均为多脏器损伤,且均经手术确诊,胃肠等空腔脏器损伤4例次,肝脾等实质脏器损伤4例次,治愈5例,死亡1例。结论重视外伤后症状和体征的动态观察,充分掌握腹腔穿刺的诊断方法,选择合理的辅助检查方法,努力提高早期诊断率。     

Traumatic abdominal wall herniation

Most reported cases of traumatic abdominal wall herniation result from seatbelt or handlebar injuries. The diagnosis is often made on physical examination or abdominal computed tomography (CT). We report a 59-year-old man with traumatic herniation through the rectus muscle following low-velocity blunt abdominal trauma. This patient was initially thought to have a rectus sheath haematoma and initial CT showed a soft tissue haematoma over the left lower anterior abdominal wall but no herniation. The traumatic herniation was diagnosed four days later, and confirmed on CT. Intraoperatively, a segment of the sigmoid colon was found to have herniated through the rectus defect and was gangrenous with impending perforation. A left hemicolectomy followed by primary repair of the defect was done. This case highlights the need for a high index of suspicion for traumatic herniation in patients who sustain low-velocity blunt abdominal wall trauma even when initial CT scans are negative.     

521例腹部创伤的救治分析

目的：总结腹部创伤救治经验。方法回顾性分析2005年6月至2012年5月该院收治的521例腹部创伤患者临床资料。结果521例腹部创伤患者损伤严重度（ISS）评分8～65分,平均23．6分。钝性伤453例,穿透伤68例。入院时休克231例（44．3％）。腹内损伤脏器777例次。腹部创伤手术率83．5％。合并多发伤331例。死亡34例（6．53％）中,平均 ISS 评分43．6分,死因为失血性休克13例：肝脏伤大出血 7例,腹内大血管伤4例,肺门血管伤2例;颅脑伤 7例;心脏 4例;胸腔严重感染致 ARDS 3例;术后腹腔间室综合征（ACS）1例;术后全身炎症反应综合征（SIRS）和多器官功能不全综合征（MODS）9例。存活者中与腹部创伤相关并发症发生率12．3％（60／487）,主要为感染和出血。结论凡腹腔完整性被破坏均应手术探查;紧急情况下采用损伤控制原则（DCS）而不强求依据器官损伤分级决定手术方案;急诊室剖腹可提高腹内大血管伤救治成功率;重视“致死三联征”前兆,在其发生时应迅速终止手术。     

Recurrent pneumothorax following abdominal paracentesis

A 62 year old man presented with abdominal ascites, without pleural effusion, due to peritoneal mesothelioma. He had chronic obstructive airways disease and a past history of right upper lobectomy for tuberculosis. On two occasions abdominal paracentesis was followed within 72 hours by pneumothorax. This previously unreported complication of abdominal paracentesis may be due to increased diaphragmatic excursion following the procedure and should be considered in patients with preexisting lung disease.     

Pattern of abdominal injuries in Aminu Kano Teaching Hospital,Kano

This study was carried out to look at the pattern of abdominal trauma in Kano, and to compare our findings with those of other centres in Nigeria, and elsewhere. This was a retrospective analysis of all cases of abdominal trauma seen and operated upon from January 1997 to December 2001, in Aminu Kano Teaching Hospital, Kano. Sixty-seven patients were managed during the study period. They were all males, with a peak age range of 20 - 29 years. Penetrating abdominal injury occurred in 36 patients (53.7%), with 15 of them (44.4%) arising from missile injuries. Thirty-one patients (46.3%) sustained blunt abdominal trauma, mainly from road traffic accidents in 80.6% of cases. The spleen was the most commonly injured organ in blunt abdominal trauma occurring in 18 patients (58.1%), while in penetrating injury, it was the small bowel in 19 patients (55.5%). The mortality rate in this study was 8.9%. Abdominal injuries are quite common in Nigeria and remain a major source of morbidity and mortality. Preventive strategies should be focused on reduction of road traffic accidents, violent crimes and social conflicts.     

An epidemiological analysis of patients with abdominal trauma in an eastern Indian metropolitan city

The profile and pattern of abdominal trauma is changing with progressing civilisation. We are lacking epidemiological data from most parts of the world. This study was conducted to prepare a database in our set up and look into the pattern of abdominal trauma, make an aetiological correlation of abdominal trauma with the types of injuries, identify the preventable factors causing delay in intervention and, compare the data with the other available national and international data. This prospective, observational study was done in a teaching hospital in a metropolitan city of eastern India. Records of patients with abdominal trauma were collected in predesigned forms, from admission to discharge. Data were analysed applying standard statistical techniques. Males (87.3%) predominated with the age range between 21 and 30 years, and the majority (73.5%) had blunt abdominal trauma. Compression injury (57.3%) commonly caused blunt trauma and stab injuries caused majority of penetrating trauma. The commonest organ injured both in blunt and penetrating trauma was small bowel (30.7% and 33.3% respectively). It was found that prehospital trauma care is virtually non-existent in this region. We are lacking a uniform protocol for the management of abdominal trauma across the hospitals. With the availability of better investigational modalities we are moving more towards a conservative approach to the abdominal trauma patients, especially the blunt abdominal trauma patients with solid organ injuries.     

经皮肾镜穿刺用微创扩张引流套件在腹腔穿刺置管引流中的应用

目的探讨微创扩张引流套件在腹腔穿刺置管引流术中的作用,解决一般穿刺置管法放置的引流管管腔偏小,容易堵塞的问题。方法总结我院2005-2010年腹腔穿刺置管引流的病例46例,其中应用Sedinger法留置中心静脉导管作腹腔引流管者29例（甲组）,应用微创扩张引流套件扩张后留置单腔导尿管作为腹腔引流管者17例（乙组）。比对两种方法在负性事件（包括管道堵塞、出血、腹腔脏器损伤、管周多量渗液）方面的差异。结果应用微创扩张引流套件组管道堵塞率低于应用中心静脉导管组,差异有统计学意义（P〈0.05）。在所统计其他负性事件发生率方面,两组差异无明显统计学意义。结论微创扩张引流套件在腹腔穿刺置管术中引流效果良好,并发症发生率低,在注意操作技巧及腹壁解剖特点的情况下有较高的可行性、安全性及实用性。     

腹部闭合性损伤早期诊断的难点及对策

目的:总结腹部脏器闭合性损伤的诊治方法,提高腹部闭合性损伤的诊疗救治水平。方法:回顾性分析169例腹部脏器闭合性损伤患者的诊治情况,总结相关的经验和教训。结果:169例腹部闭合性损伤患者中,腹腔穿刺检查、B超、CT及X线检查阳性率分别是91.1%、92.3%、91.8%及34.3%。结论:腹腔镜检查对腹部闭合性损伤诊治是一种积极、微创、有效的诊疗方法。及时地腹腔穿刺和必要的B超检查是简单、安全、有效的诊断方法。合理的CT和X线检查具有较高的诊断价值。选择性水溶性造影剂消化道造影可进一步明确十二指肠或结直肠损伤的诊断。腹腔镜技术为闭合性腹部损伤的早期诊断及处理提供了又一科学手段。     

Penetrating abdominal wounds. Rationale for exploratory laparotomy

Over the past decade a general consensus has evolved about the indications for celiotomy after civilian penetrating wounds. Stab injuries to the anterior part of the abdomen clearly warrant a selective approach based on physical signs, local wound exploration, and diagnostic peritoneal lavage. Gunshot wounds violating the peritoneum, on the other hand, mandate abdominal exploration. Peritoneal lavage is also valuable for the selective management of lower thoracic penetrating wounds. Back and flank injuries are difficult to assess, and patient care must be individualized with the assistance of retroperitoneal contrast studies. Although the adjunctive role of peritoneal lavage in the evaluation of penetrating wounds has substantially reduced unnecessary celiotomy, the safest policy is to explore the abdomen if any question of visceral injury exists.     

76例腹部闭合性损伤的诊治分析

目的:探讨腹部闭合性损伤诊断、治疗的方法与原则,提高治愈率.方法:回顾分析76例腹部闭合性损伤患者的临床资料.结果:76例腹部闭合性损伤患者治愈72例,死亡4例,住院10～50 d,平均20 d.结论:腹部闭合性损伤早期诊断、早期治疗、准确掌握手术时机是关键.     

腹部创伤早期再手术的临床分析

目的探讨腹部创伤再手术的原因和预防。方法回顾分析32例腹部创伤再手术病人的情况。结果再手术病例占同期915例创伤剖腹病人的3．5％。钝性伤20例，穿透性伤12例。再手术原因主要为手术漏诊（9例），处置失误（10例），并发症（13例）。病死率9．4％（3／32），主要死亡原因为再手术后严重感染并发多器官功能障碍综合征（MODS）。再手术与受创伤的类型无明显相关。因漏诊、处置失误和并发症而再手术的构成比分别为28．1％、31．3％和40．6％。结论腹部创伤早期再手术率和再手术原因与受伤的类型无明显关系。腹部创伤手术时只要坚持全面探查，正确掌握手术操作技术和重视腹部创伤的充分引流，术后规范化治疗，早期再手术是可以降低的。     

全腹部64层螺旋CT(MSCT)增强扫描诊断创伤所致腹部脏器损伤的临床应用

目的 观察全腹部64层螺旋CT(MSCT)增强扫描诊断创伤所致腹部脏器损伤的临床应用价值.方法 选取丽水市中心医院治疗的腹部创伤患者957例,利用64层螺旋CT增强扫描,并将CT的诊断结果与手术、治疗结果进行对照,观察MSCT增强扫描诊断创伤所致腹部脏器损伤的特异性和敏感性.结果 CT的诊断结果与术后、治疗的结果相比,最后发现在实质脏器的损伤诊断中假阳性为5例、假阴性为3例;而在空腔脏器的CT诊断结果上假阳性为4例、假阴性为3例.CT诊断实质脏器损伤的灵敏度为97.86％,特异性为99.59％; CT诊断空腔脏器损伤的灵敏度为76.67％,特异性为99.89％.结论 全腹部MSCT增强扫描诊断腹部实质脏器损伤的特异性与诊断腹部空腔脏器损伤的特异性无显著统计学差异(P＞0.05),但是其诊断腹部实质脏器损伤的灵敏度却要显著高于空腔脏器损伤的灵敏度(P＜0.05).     

腹腔镜技术诊治闭合性腹部创伤39例临床分析

目的探讨闭合性腹部创伤中腹腔镜技术的临床应用价值。方法回顾分析应用电视腹腔镜技术诊治39例闭合性腹部创伤患者的临床资料。结果39例伤者均在腹腔镜下明确诊断。35例在腹腔镜下或腹腔镜辅助下手术处理损伤,取代治疗性剖腹手术,术后恢复快且佳;4例中转剖腹手术,恢复顺利。上述伤者均未发生手术并发症,痊愈出院。结论腹腔镜技术诊治闭合性腹部创伤,可明确诊断,避免阴性剖腹探查手术;可腹腔镜下或腹腔镜辅助下手术处理损伤,取代治疗性剖腹手术;还能指导剖腹手术的切口选择及术式;并具有创伤小,术后恢复快的特点。只要应用得当,就能使病人以最小的创伤获得最佳的诊治效果,适合基层医院开展。     

Beware the boogie board: blunt abdominal trauma from bodyboarding

Riding waves on a bodyboard (boogie board) at the beach is popular with children. Three teenagers who sustained blunt abdominal trauma during bodyboarding are described. Two suffered lacerated livers, one a lacerated spleen. Serious blunt abdominal injuries from bodyboarding mishaps have not previously been reported. The usual method of riding a bodyboard may place the rider at risk of abdominal trauma.     

腹腔镜技术诊治闭合性腹部创伤39例临床分析

目的 探讨闭合性腹部创伤中腹腔镜技术的临床应用价值。方法 回顾分析应用电视腹腔镜技术诊治39例闭合性腹部创伤患者的临床资料。结果 39例伤者均在腹腔镜下明确诊断。35例在腹腔镜下或腹腔镜辅助下手术处理损伤，取代治疗性剖腹手术，术后恢复快且佳；4例中转剖腹手术，恢复顺利。上述伤者均未发生手术并发症，痊愈出院。结论 腹腔镜技术诊治闭合性腹部创伤，可明确诊断，避免阴性剖腹探查手术；可腹腔镜下或腹腔镜辅助下手术处理损伤，取代治疗性剖腹手术；还能指导剖腹手术的切口选择及术式；并具有创伤小，术后恢复快的特点。只要应用得当，就能使病人以最小的创伤获得最佳的诊治效果，适合基层医院开展。     

CT导引下胸腹部穿刺活检

目的 讨论CT导引下以皮胸，腹部穿刺予脱落细胞学检查的临床意义及其操作体会。方法 回顾性分析61例胸，腹部疾病（肺部31例，肝脏25例，后腹膜5例）介入术前予以CT导引下穿刺活检资料。结果 经手术证实及临床随访观察，恶性肿瘤的穿刺活检阳性率为91．07％（51／56）；假阴性率为8．93％（5／56），假阳性为0（0／61）。2例气胸，无出血，空气栓塞及针道种植。结论 CT导引下胸腹部穿刺活检具有操作简便，并发症少，特异性强的细胞学诊断的优点；要对有可能出现的假阴性有足够的认识，多次穿刺及结合临床和影像学资料有助于提高其诊断的正确性。