开放性腹部刀刺伤39例诊治体会

开放性腹部刀刺伤是常见的腹部外伤之一，我科收治开放性腹部刀刺伤39例，总结报道如下。     

腹部刀刺伤42例诊治体会

腹部刀刺伤所致的腹腔内脏器损伤在腹部外伤中较常见 ,准确、及时的诊断和治疗对抢救伤员生命和预后有重要意义。我科 1989年～ 1998年收治腹部刀刺伤 4 2例。现报道如下。临床资料1.一般情况 :本组男 39例 ,女 3例 ;最大年龄4 8岁 ,最小年龄 16岁 ,平均年龄 32岁。穿透伤 34例 ,非穿透伤 8例。Ｍｏｏｒｅ穿透指数 (ＰＡＴＩ) >2 5分者 4例 ,12～ 2 4分者 2 6例 ,<12分者 14例。2 .刀刺部位及伤情 :右季肋区 9例 ,腹中上区 7例 ,左季肋区 12例 ,腹中区 3例 ,左外侧区 4例 ,右腹股沟区 3例 ,左腹股沟区 1例 ,腰部 2例 ,左腹股沟区及左季肋区 …     

腹部刀刺伤诊治体会(附147例报告)

目的：探讨腹部刀刺伤的诊断与治疗。方法：回顾性总结分析147例腹部刀刺伤患者的临床资料。结果：147例患者中，腹腔脏器从伤口脱出43例，其中大网膜脱出39例．小肠脱出1例，胃脱出1例，结肠脱出2例。伴失血性休克28例。全组病例中行剖腹探查手术139例，伤口清创缝合8例；治愈145例，死亡2例。结论：腹部刀刺伤合并休克，有大网膜及腹腔脏器外脱，腹痛伴腹膜炎体征，诊断性腹腔穿刺阳性均是手术指征。臀部刀刺伤要警惕损伤腹腔脏器。合并胸部伤或发生胸腹联合伤时，除有心脏大血管损伤外，原则上应先剖腹，术前置胸腔引流观察胸腔出血、漏气情况，改善呼吸。     

腹腔镜诊治腹部开放性刀刺伤22例报告

目的:总结腹腔镜诊治腹部开放性刀刺伤的经验。方法:对2004年至2007年用腹腔镜诊治的22例腹部开放性刀刺伤患者的临床资料进行回顾性分析。结果:单纯腹壁穿透伤14例,小肠破裂5例,结肠破裂1例,胃破裂1例,大网膜血肿1例。腹壁穿透伤患者均行清创缝合术;3例小肠破裂及1例胃破裂患者在腹腔镜下行胃肠破裂修补术,2例在腹腔镜辅助下行小肠部分切除术;结肠破裂患者中转开腹行右半结肠切除术。术后均痊愈出院。结论:腹腔镜对腹部开放性刀刺伤的诊断和治疗有较高的价值。     

腹部刀刺伤手术63例诊治体会

目的探讨腹部刀刺伤的诊断及治疗。方法总结分析我院近5年63例腹部刀刺伤手术的诊断和治疗方法。结果治愈63例,死亡1例。结论休克、大网膜及腹腔脏器外脱、腹痛伴腹膜炎体征、诊断性腹腔穿刺阳性均是手术指征。复合复杂刀刺伤及时行CT检查有助于病情诊断。术中仔细探查腹腔脏器、避免漏诊漏治,是腹部刀刺伤的诊治关键。     

腹部刀刺伤49例治疗分析

目的 探讨腹部刀刺伤病人的诊断及治疗. 方法 回顾性分析近8年来本院收治的腹部刀刺伤病人的治疗情况. 结果 49例腹部刀剌伤病人,均行剖腹探查术,术后并发膈下、盆腔脓肿各1例,肺部感染1例,肠梗阻2例,治愈48例,死亡1例. 结论 对腹部刀刺伤病人应迅速地作出诊断,及时剖腹探查,术中仔细探查,避免漏诊,是治疗腹部刀刺伤的关键.     

腹部刀刺伤58例的治疗分析

本院自1995年1月-2004年12月共收治腹部刀刺伤病人58例。现将治疗情况分析报告如下。     

腹部刀刺伤的诊治体会

近年来,腹部刀刺伤发生率呈上升趋势,成为普外科常见的急腹症之一。腹部刀刺伤多由暴力事件引起,损伤腹腔脏器机会较大,最常见合并胸腔脏器伤。而且腹部刀刺伤来势急,病情复杂,腹腔胸腔脏器损伤易漏诊漏治,术后易发生并发症,如感染、应激性溃疡甚至心肌缺血等。现将关于腹部刀刺伤的诊治情况结合笔者的经验总结如下。     

腹腔镜诊治开放性腹部刀伤病例报告与分析

目的 总结腹腔镜诊治腹部开放性刀刺伤的经验.方法选择2007年3月至2011年3月,在本院收治并在腹腔镜下行腹腔探查及相应手术治疗的腹部开放性刀刺伤患者25例.5例单纯腹壁贯通伤行腹壁清创缝合术,4例小肠破裂及1例胃破裂患者在腹腔镜下行胃肠破裂修补术;另3例小肠破裂行选择性小切口开腹小肠部分切除术;4例大网膜及2例肠系膜破裂在腔镜下缝扎止血术;4例结肠破裂患者中转开腹2例行结肠造口、另2例行破裂口缝合＋近端肠管造口术.2例膀胱破裂请泌尿科1例行腔镜下修补、另1例行小切口开腹修补术.结果所有患者均经腹腔镜探查得到明确诊断及进一步治疗,平均手术时间（37.35±8.69）分钟,术后肛门排气时间平均（2.49±0.25）天,平均住院时间（4.87±0.98）天,均治愈出院,随访至今无并发症出现.结论腹腔镜诊治腹部开放性刀刺伤,具有创伤小、诊断率高、协助开腹手术方式选择、愈合快的优点,适合在腹部外伤急诊中推广应用.     

腹部刀刺伤39例报道

腹部刀刺伤近年来有上升趋势。我院1989．7～2000．11共收治腹部刀刺伤患39例。现将诊治体会报告如下。     

Laparoscopy offers diagnosis and treatment in abdominal stab injuries

PURPOSE: To assess the role of laparoscopy in the diagnosis and treatment of abdominal stab injuries (ASI). METHODS: Patients who underwent laparoscopic procedures due to ASI were included in the study. Hemodynamic instability, injuries to the posterior trunk, concomitant severe cranial injuries, and prior abdominal operations were considered as contraindication for laparoscopy. RESULTS: From January 1997 to March 2006, 88 patients underwent laparoscopic management of ASI. In 45 patients (51.1%), there was no intra-abdominal pathology requiring surgical intervention (nontherapeutic laparoscopy) and 5 patients in this group had no peritoneal penetration (negative laparoscopy). In another 25 patients (28.4%), laparoscopic treatment was performed (therapeutic laparoscopy), including bleeding control in liver, colonic, gastric, and diaphragmatic repairs and intra-abdominal bleeding control. Laparotomy was avoided in a total of 70 (79.5%) patients. In 18 patients (20.5%), laparoscopy was converted to laparotomy. There was no mortality, and except one missed small bowel injury nor perioperative morbidity in patients undergoing laparoscopy. In the laparotomy group, major complications were seen in 7 patients. CONCLUSIONS: Laparoscopy is safe and efficient in the management of ASI and should be more frequently considered as a therapeutic tool.     

腹腔镜探查在腹部外伤诊治中的应用

目的:探讨腹腔镜技术诊治腹部外伤的应用价值。方法:回顾分析32例腹部外伤患者行腹腔镜探查的临床资料。结果:32例均经腹腔镜探查明确诊断,无漏诊、误诊。26例(81.25%)在腹腔镜下完成手术处理,包括6例脾破裂修补术,3例脾切除术,4例肝破裂修补术,2例结肠破裂修补术,1例结肠造瘘术,4例小肠破裂修补术,2例胃破裂修补术,1例胰体损伤行损伤限制性病损清除引流术,2例肠系膜破裂缝合术,1例腹壁损伤腹膜缝合术。6例(18.75%)伤情较重的患者在腹腔镜指导下中转开腹,1例术后出血二次手术。患者均痊愈出院,无死亡病例。住院3~12 d,平均(7.2±2.88)d。结论:腹腔镜探查诊治腹部外伤具有创伤小、准确性高、并发症少、康复快、死亡率低的优点,较传统剖腹探查术具有显著优势,值得推广应用。     

脊髓锐器伤的诊断与治疗特点

目的探讨脊髓锐器伤的损伤特点、临床表现、治疗及预后。方法对1992年至2004年12年间42例脊髓锐器伤的临床资料进行回顾性分析。结果本组男性病例38例,女性4例,平均年龄23.6岁。脊髓损伤节段在胸段脊髓者32例（占76.0％）;完全性损伤12例（占28.6％）;不完全性损伤30例（占71.4％）。不完全损伤中典型Brown-Sequard综合征14例（占46.7％）;不典型Brown-Sequard综合征6例（占20.0％）;非Brown-Sequard综合征10例（占33.3％）。MRI对指导脊髓锐器伤的诊断和治疗价值很大;急性期常规行清创缝合术,根据具体情况,行椎管探查、血肿清除、异物取出等手术;经过治疗与康复,本组病例入院和出院的ASIA评分和ADL评分都有明显提高。结论临床上处理脊髓锐器伤病例时,要根据其特点了解在诊断和治疗上特殊性,以便更快更有效地促进此类脊髓损伤的功能恢复。     

腹部刀刺伤97例诊治分析

目的探讨腹部刀刺伤的诊断及治疗。方法回顾性分析我院2004年1月至2008年12月收治的97例腹部刀刺伤手术的临床资料。结果本组治愈96例。其中,手术92例,均为腹壁穿透伤,剖腹探查未见脏器损伤12例;非手术治疗4例,均为腹壁损伤。死亡1例。结论休克、大网膜及腹腔脏器外脱、腹痛伴腹膜炎体征、诊断性腹腔穿刺阳性均是手术指征。复合、复杂刀刺伤及时行CT检查有助于病情诊断。术中仔细探查腹腔脏器,避免漏诊、漏治,是腹部刀刺伤的诊治关键。     

提高腹部损伤的诊断治疗水平

目的 提高腹部损伤的诊治水平。方法 介绍腹部损伤诊断治疗中应注意的问题。结果与结论 腹部损伤中多发伤多，死亡率高，腹部损伤的诊断要注意临床征象和采用简易可行的检查方法，避免延误诊治；应注意总结经验，学习新知识，新进展，并加强实践，以不断腹部损伤的诊治水平。     

腹腔镜在诊断不明确的急腹症和腹部外伤诊治中的应用

目的 探讨和分析腹腔镜诊断和治疗急腹症及腹部外伤的价值.方法 对具有开腹探查指征的61例不明确诊断的急腹症及腹部外伤患者进行腹腔镜探查,根据探查情况决定具体术式.结果 61例均行腹腔镜探查,60例明确诊断,50例避免开腹手术,手术并发症3例,无死亡病例.结论 腹腔镜技术不仅对外科急腹症和腹部外伤能明确诊断,避免不必要的开腹探查,同时又能进行腹腔镜下手术治疗,具有良好的临床应用价值.     

腹腔镜在妊娠期急腹症诊疗中的应用

目的 评价腹腔镜在妊娠期急腹症的临床诊疗价值. 方法 回顾分析1997年6月～2004年10月40例孕周在7～17周（平均13.2周）的妊娠期急腹症临床资料,其中宫内宫外妊娠16例,卵巢扭转3例,卵巢囊肿蒂扭转5例,急性胆囊炎5例,急性阑尾炎11例,应用腹腔镜诊断及治疗. 结果 40例均在腹腔镜下明确诊断,除1例宫内宫外妊娠盆腔粘连严重中转开腹外,余全部手术成功.手术时间25～70 min,平均38.2 min.术后皮下气肿1例.术后随访36例,先兆流产3例,难免流产3例,早产1例,足月分娩31例. 结论 腹腔镜手术治疗早、中期妊娠急腹症安全有效.     

Evolution-based algorithm for the management of penetrating abdominal stab injury

Purpose

As an increasing amount of penetrating abdominal stab injuries has been observed in the last few decades, it is important to evaluate the adequacy of the medical systems and surgical education and training to handle this type of injury. The aim of this study was to analyze the outcome of patients with penetrating abdominal stab injuries admitted to the Emergency Unit and to evaluate the effects of using a new treatment algorithm.

Methods

From January 2009 to April 2009, a standardized education and training system for the surgical team was implemented in order to improve the emergency medical care system. From April 2009 to April 2011, 106 patients with the diagnosis of a penetrating abdominal stab injury were prospectively included in the study.

Results

The cohort included 98 males and the mean age was 29.40?±?10.9 years. Eighty-two percent of the patients were managed conservatively, whereas 18?% underwent surgery. Based on the surgical outcomes of the patients, the rate of negative, non-therapeutic, and therapeutic laparotomies was 5, 11, and 84?%, respectively. No statistically significant difference between patients who did and did not receive surgery was observed with regards to blood pressure, temperature, hematocrit, hemoglobin, and C-reactive protein (CRP) values. However, a statistically significant difference was observed in the pulse rate, leukocyte, and neutrophil counts. The mortality and morbidity rates were 0.94 and 3.77?%, respectively.

Conclusions

Selective non-operative management, which has been standardized in trauma centers, may be carefully utilized in order to treat penetrating abdominal stab wounds with caution in well-equipped medical centers with well-trained staff.     

腹腔镜在腹部闭合性损伤中的应用价值

目的：探讨腹腔镜在腹部闭合性损伤中的应用价值。方法：回顾性分析38例患者应用腹腔镜诊断与治疗腹部闭合性外伤的效果。结果：经腹腔镜探查38例全部明确诊断。36例同时进行治疗,2例无需手术处理,避免了不必要的开腹手术,中转开腹10例,无并发症和死亡病例。结论：腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高等优点,并有效降低阴性剖腹探查率,适用于大部分腹部外伤的病例。     

Inferior vena caval injury following self-inflicted abdominal stab wound

A rare case of attempted suicidal abdominal stabbing using a shoemaker’s piercing awl is reported. The patient presented with the weapon still in place. On emergency exploration, injury to the inferior vena cava and the inferior mesenteric artery were found. The case highlights the fact that major vascular injury may be present in patients of abdominal stabs with retained weapons inspite of their haemodynamic stability. It also illustrates the importance of manipulating retained weapons only after complete exposure with adequate preparation for a vascular procedure.