目的:探討四川汶川地震腹部損傷傷員CT表現及其診斷價值。方法:對我院因汶川地震受傷,需做腹部CT的傷員27例的治療,進行CT分析。結果:在本組腹部損傷傷員中, 肝臟病變7例,膽囊病變2例,胰腺病變11例,脾臟病變8例,腎臟病變11例,腹腔積液6例,腹腔積氣9例,胃腸道病變8例,子宮病變1例。部分傷員為兩個或兩個以上器官受累。結論: CT檢查結合臨床治療能快速、準確、有效的對地震腹部損傷傷員進行判斷,對臨床診治具有重要作用。
ObjectiveTo establish pig abdomen bullet wound model in seawater immersion condition and to analyze injury characteristics. MethodsTwenty Xishuangbanna pigs were randomly divided into seawater immersion group and control group,with 10 in each group.The left lower quadrant anti McBurney point of the pig semi-floating in the seawater was shot by using domestic 81-1 assault rifle at the distance of 10 meters,which were salvaged out of seawater at 60 minutes after injury in the seawater immersion group.The pigs in the control group were treated same as the seawater immersion group except seawater immersion.The mean arterial pressure (MAP),rectal temperature (RT),heart rate (HR),respiratory (R),white blood cell count (WBC),and C-reactive protein (CRP) were tested at 1 h,4 h,8 h after injury.The death of pig was observed. ResultsThe pig abdomen bullet wound models in the seawater immersion condition were successfully established.① Compared with the control group,the MAP and RT were significantly decreased at 1 h,4 h,8 h after injury,the HR or the R was significantly decreased at 4 h or 8 h after injury respectively in the seawater immersion group.② Compared with the normal value,the WBC obviously rose at 4 h and 8 h after injury,the CRP obviously rose at 1 h,4 h,and 8 h after injury in both two groups.Compared with the control group,the WBCs were significantly increased at 4 h and 8 h after injury (P<0.05),the CRPs were significantly increased at 1 h,4 h,and 8 h after injury (P<0.05) in the seawater immersion group.③ The mortality in the seawater immersion group (50%) was significantly higher than that in the control group (20%,P<0.05). ConclusionThe injury is more serious,the infection time is earlier,and the infection degree is aggravated,the mortality rate is higher for pig abdomen bullet wound model in seawater immersion condition.
Objective To investigate the reasons of misdiagnosis and missing diagnosis in blunt abdominal trauma (BAT), and to put forward effective preventive measures. Methods Literature on BAT diagnosis in recent years was reviewed. Results Misdiagnosis and missing diagnosis, which can take place in every segment of BAT patients, were still quite common nowadays. Conclusion Detailed case history collecting, faithful medical examination and making good use of assistant examinations can efficiently decrease the misdiagnosis and missing diagnosis rates of BAT patients.
【摘要】目的探討肝移植術后再次腹部手術的圍手術期處理。方法對7例肝移植術后再次腹部手術患者的資料進行回顧性分析。結果5例擇期手術患者圍手術期平穩，痊愈出院。2例急診手術患者中1例術后因并發上消化道應激穿孔、出血和切口感染自動出院。結論肝移植術后再次腹部擇期手術的風險較急診手術者低，與非肝移植行類似手術者相仿。
目的探討腹腔鏡在腹部外傷診斷與治療中的應用價值。方法 對36例腹部外傷患者行腹腔鏡探查術，首先明確診斷，根據不同的損傷臟器和類型，進行腹腔鏡下處理，處理困難或無效時及時中轉開腹。結果本組病例術中均明確診斷。10例開放性腹部外傷中，胃破裂傷2例，肝裂傷2例，脾破裂1例，小腸破裂傷2例，大網膜損傷1例，腸系膜血管破裂1例，單純腹壁裂傷1例。26例閉合性腹部外傷中，胃破裂2例，肝破裂7例，脾破裂12例，小腸破裂2例，腸系膜血管破裂1例，單純腹膜后血腫2例。于腹腔鏡下行縫合、修補、電凝、明膠海綿止血等治療20例（55.6%），10例（27.8%）未做特殊處理，6例（16.6%）中轉開腹。本組病例術中出血量為55~1 800 ml（平均520 ml），手術時間為60~186 min（平均128 min）。 所有病例均放置腹腔引流2~5 d（平均3 d），住院時間3~16 d（平均9 d）。全組均無氣腹相關并發癥和死亡病例。結論腹腔鏡診治腹部外傷具有創傷小、診斷率高、恢復快等優點，大部分病例還可在腹腔鏡下達到診治一體化的目的。
目的 探討經陰道B型超聲（B超）在診斷早期宮外孕中的臨床應用價值。 方法 回顧分析2011年5月－2012年3月應用陰道B超與腹部B超對78例宮外孕患者進行對比檢查的臨床資料并回顧性分析，評價兩種檢查方法的臨床效果。 結果 78例宮外孕患者，應用經陰道B超檢查診斷準確率為97.44%，應用腹部B超準確率為61.54%，差異具有統計學意義（χ2=6.472，P＜0.05）；經陰道B超檢查診斷附件包塊、宮內假孕囊、心血管搏動、胚芽、盆腔積液的檢出率明顯高于經腹部B 超檢查的檢出率（P＜0.05）。 結論 陰道B超具有操作簡單、快速、無副作用、無需充盈膀胱等優點，在宮外孕的早期診斷中具有絕對的優越性，為臨床提供了更方便、更快捷的診斷手段，減輕了患者痛苦，提高了診斷的準確率，值得臨床廣泛推廣和應用。