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1 47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。
Objective To analyze the outcome of patients with Blunt Abdominal Injury (BAI) in the Deyang People’s Hospital after the Wenchuan Earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of BAI patients. Methods Data on the BAI patients within 1 week after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 23 BAI inpatients were treated, of whom 15 were from Mianzhu City and sent to hospital within 12 hours of the earthquake. This was 1.9% of the total inpatients. The BAI inpatients suffered severe and complex injuries, and 5 of them died (mortality rate: 22%). Linenectomy was conducted for patients with spleen injuries and two inpatients developed incision infection due to lack of antibiotics during the perioperative period. Conclusions It is important to establish an emergency response mechanism for medical rescue for patients with the viscera injury, including BAI, after an earthquake. This would help to guarantee rational allocation of the rescue workers, triage of the wounded, optimization of operation, as well as a reduction in mortality from BAI.
Objective To analyze the outcome of patients with abdominal injury (AI) in the Chengdu Army General Hospital within 48 hours after the Wenchuan earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of AI patients. Methods Data on the AI patients within 48 hours after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 33 AI inpatients were treated which was 3.1% of the total inpatients. The AI inpatients suffered severe and complex injuries, and one of them died (mortality rate: 3%). Conclusion As a second-line Grade-A hospital,prompt triage is very important to patients who were rescued 48 hours after the earthquake. Reasonable damage control surgery and remedies prepared by medical staff from different specialties after the operations may decrease mortality rate.
目的:探讨超声检查在腹部闭合性损伤内脏破裂出血的应用价值。方法:对92例腹部闭合性损伤内脏破裂出血患者进行全面、细致的超声检查,并收集其手术、病理结果。结果:本组病例超声与手术结果完全相符者83例(占90.2%),基本相符者6例(占6.5%),漏诊3例(占3.3%)。其中脾破裂49例,肝破裂16例,肾破裂14例,胰腺损伤1例,肠破裂6例,复合性内脏破裂6例。92例患者均伴有腹腔积液,超声检出率100％(92／92)。结论:超声能迅速、较准确地对腹部闭合性损伤内脏破裂出血作出诊断,尤其诊断实质性脏器破裂比空腔脏器破裂更有特异性,具有重要的临床价值。
目的:探讨四川汶川地震腹部损伤伤员CT表现及其诊断价值。方法:对我院因汶川地震受伤,需做腹部CT的伤员27例的治疗,进行CT分析。结果:在本组腹部损伤伤员中, 肝脏病变7例,胆囊病变2例,胰腺病变11例,脾脏病变8例,肾脏病变11例,腹腔积液6例,腹腔积气9例,胃肠道病变8例,子宫病变1例。部分伤员为两个或两个以上器官受累。结论: CT检查结合临床治疗能快速、准确、有效的对地震腹部损伤伤员进行判断,对临床诊治具有重要作用。
目的 提高腹部锐器伤的诊断和治疗水平。方法 总结分析我院普外科1990年1月至1999年6月所收治的200例腹部锐器伤患者的资料。结果 男女比例7∶1，小于45岁者占75%，就诊平均时间3.8小时，95%为斗殴刀刺伤。单纯腹壁贯通伤占20%，单个脏器损伤占34%，多个脏器损伤占46%，休克发生率为26%。保守治疗20例，均为单纯腹壁贯通伤，手术治疗180例，总死亡率为2%。结论 腹部锐器伤的诊断虽然较为直观，但在6种特殊情况下容易延误诊断： ①腹内脏器损伤后的延时表现； ②经胸穿透膈肌导致腹内脏器损伤； ③经剑突下方刺伤并穿透膈肌导致心脏损伤； ④在受伤现场及来院途中的大量外出血导致休克； ⑤腹膜后血肿的诊断； ⑥直肠腹膜外损伤导致盆底腹膜贯通及腹内脏器损伤。在治疗方面，笔者强调了手术探查时的6项要点，并对各类脏器损伤的处理要点提出建议。
目的 探讨腹部刀刺伤诊治策略，提高治疗水平。方法 回顾性总结分析147例腹部刀刺伤的诊断和治疗。结果 剖腹手术139例，伤口清创缝合8例，治愈145例，死亡2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。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。
ObjectiveTo investigate the role of somatostatin in gastrointestinal function after operation for treatment of abdominal injury patients. MethodsSixty patients with abdominal trauma were divided into somatostatin in treatment group (n=30) and the conventional treatment control group (n=30). The amount of gastrointestinal decompression drainage, bowel sounds recovery time, exhaust time, defecation time, and the levels of serum C reactive protein, TNF-α, IL-6, and IL-8 after operation in two groups were observed. ResultsSomatostatin treatment group recovery time of bowel sounds, exhaust time, and defecation time were earlier than the control group, hospitalization time shortened, and the amount of gastrointestinal decompression drainage reduced (P < 0.05), The levels of serum C reactive protein, TNF-α, IL-6 and IL-8 of somatostatin treatment group were lower than those in control group (P < 0.05), and the magnitude of decline above index in the somatostatin treatment group were greater than that in the control group (P < 0.05). ConclusionSomatostatin can promote the recovery of gastrointestinal function in patients after operation in abdominal injury.
Objective To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma. Methods Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected. The injury causes, diagnostic methods, surgical treatment methods, curative effect, and complications of patients were analyzed. Results A total of 8 patients were included. Among them, there were 7 males and 1 female. The age ranged from 17 to 66 years old, with an average of (44.4±19.3) years old. There were 5 cases of traffic accident injury, 2 cases of crush injury, and 1 case of falling injury. There was 1 case of duodenal bulb injury, 3 cases of descending part injury, 3 cases of horizontal part injury and 1 case of both descending and horizontal injuries. According to the scale of American Association for the Surgery of Trauma for duodenal trauma, there were 5 cases of grade Ⅱ injury, 2 cases of grade Ⅲ injury, and 1 case of grade Ⅳ injury. All patients underwent CT scan, of which 2 cases were directly diagnosed with duodenal injuries by CT, and the remaining cases diagnosed by intraoperative exploration. All patients underwent surgical treatment, including 4 cases of pancreaticoduodenectomy, 2 cases of duodenal repair and gastrojejunostomy, 1 case of duodenal repair plus jejunostomy, and 1 case of superior mesenteric vein repair, pancreatic necrotic tissue removal, and abdominal catheterization for smooth drainage. One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery, 1 died of multiple organ failure during the resuscitation phase after damage control surgery, 3 developed intra-abdominal infection and cured by anti-infective treatment. Conclusions Early clinical manifestations of traumatic duodenal injuries are atypical, and imaging findings might not be clear. For trauma patients suspected of having duodenal injury, rigorous vital sign monitoring is necessary. Once vital signs stabilize, exploratory surgery should be actively considered to identify the location of the injury and perform appropriate surgical procedures. Adequate postoperative enteric decompression and drainage should be ensured.