创伤性脾破裂90例的诊治经验

目的:总结创伤性碑破裂的诊治经验,进一步提高救治水平.方法:回顾性分析1999～2003年间连续收治的90例脾破裂患者的诊断与治疗.结果:根据外伤史、临床表现、诊断性腹腔穿刺、腹部B超和(或)CT等检查结果,诊断符合率为96.6%.本组非手术治疗8例,全部治愈;手术治疗82例,治愈79例,其中并发症脾窝积液2例.全组共治愈87例,治愈率为96.7%;死亡3例,死于大出血和严重多发伤.结论:创伤性脾破裂行脾切除术疗效肯定,并发症发生率和病死率低,对重度失血性休克和严重多发伤患者应采取更积极的外伤治疗策略.     

延迟性腹部脏器破裂的急症诊断

腹部脏器延迟破裂由于病情隐匿,故早期诊断困难,常易失去最佳抢救、手术时机。我院近年来共收治延迟性脾破裂、肠破裂、肾挫裂伤30例,报告如下。 1 临床资料 本组男22例,女8例;年龄1 3/(12)～62岁,平均26岁。其中延迟性脾破裂12例、延迟性肠破裂4例、延迟性肾挫裂伤14例。脏器延迟破裂发生在伤后3d以内的22例,4～7d的7例,1例为外伤后第20d。24例有明显的腹、腰或下胸受伤史,6例虽有受伤史但无明显的前述3部位受伤史(多为从高处     

外伤性脾破裂诊治体会

脾脏是腹内脏器中最易受伤的器官之一,其损伤发生率占各种腹内脏器损伤的40%～50%。我院自1980年～1998年共收治外伤性脾破裂67例,现就其诊断与治疗方法讨论如下。临床资料1　一般资料本组男52例,女15例;年龄小于15岁20例。闭合性损伤64例,其中交通事故伤42例,坠落伤12例,踢伤10例,刀刺伤3例。伤后就诊时间半小时～10天。临床症状:左上腹或左季肋部创伤,左上腹痛,腹内出血征。其中休克47例,合并多发伤32例。腹穿或腹腔灌洗61例,阳性58例,阳性率95%;Ｂ超检查46例,共76次;ＣＴ检查4例,阳性率100%。本病诊断率极高,入院8小时内确诊61例,确诊率9…     

外伤性脾破裂的CT诊断

目的探讨外伤性脾破裂的CT表现及诊断价值. 资料与方法对48例成人闭合性钝性脾破裂的CT、B超表现与外科手术所见进行回顾性分析. 结果 48例中完全性脾破裂39例,中心破裂6例,3例包膜下破裂.48例均行CT检查, 46例确诊, 诊断符合率98.5%; 其中19例同时行B超检查, B超确诊17例, 诊断符合率89.4%.其CT表现为脾内血肿、脾撕裂伤、包膜下血肿、脾周血肿及腹腔积血,同时发现25例合并肝、肾、肋骨、脊柱等损伤. 结论 CT作为一种非损伤性检查手段,能迅速、准确评估脾损伤程度及出血的部位、大小以及腹腔伴随性损伤.肋骨及运动性伪影是CT诊断脾破裂过程中的主要误、漏诊原因,结合彩色多普勒超声检查,可减少运动性伪影造成的误漏诊;CT能为临床选择非手术病例提供重要帮助.     

B超诊断延迟性脾破裂的体会

延迟性脾破裂，常因病史不明确，症状不典型，体征不明显，使临床早期诊断比较困难，误诊率较高。B超能够清晰地显示脾脏形志和内部结构，明确有无腹腔积液和了解相邻脏器的情况。脾破裂时，有其特征性图象改变，是目前诊断延迟性脾破裂的有效而无损伤的穿透性检查方法。我院今年收治的二例延迟性脾破裂，经B超诊断后，     

延迟性脾破裂25例诊治体会

延迟性脾破裂（delayed rupture of spleen，DRS）是指腹部外伤48h后出现脾破裂症状，是一种特殊的脾外伤Ⅲ。其病情急，变化快，故误诊率、病死率、并发症发生率等均高于一般脾破裂。我们自1994-2004年共收治DRS25例，现报告如下。     

21例延迟性脾破裂的诊治分析

延迟性脾破裂是指腹部外伤 48ｈ后出现脾破裂症状 ,是一种特殊的脾外伤 ,其死亡率高、并发症多。我院外科1986～ 1998年收治外伤性脾破裂 140例 ,其中延迟性脾破裂 2 1例 ,占总数15 %。现对 2 1例延迟性脾破裂的诊断和治疗进行分析 ,以探讨本病的合理诊治方案。临　床　资　料本组男 19例 ,女 2例 ;年龄 12～ 6 8岁。受伤原因 :交通伤 12例 ,坠落伤 4例 ,拳击伤 2例 ,重物撞伤 2例 ,牛踢伤 1例。全组均为腹部闭合性损伤 ,均于受伤 48ｈ后出现症状。其中 2～ 7ｄ 17例(81% ) ,7～ 14ｄ 2例 ,30ｄ以上 2例。 11例首诊时症状体征不明显 ,在留院…     

延迟性脾破裂的诊断和治疗

报告18例延迟性脾破裂(DRS)的诊治体会,结合文献认为提高对DRS的认识是正确诊断的前提,诊疗程序应是:外伤→左上腹痛→B超、CT→非手术治疗→B超、CT/腹穿→手术.     

超声诊断延迟性脾破裂9例

外伤性延迟性脾破裂（delayedreputureofspleen,DRS）临床上比较少见,由于其症状隐匿,易引起漏诊和误诊。我院1997—08至2009—12经手术、CT及超声诊断外伤性延迟性脾破裂9例。     

腹痛的血管源性病变双源CT分析

目的：通过对血管源性病变导致腹痛的 CT 分析,提高对该类疾病的认识,减少漏诊率。方法回顾性分析69例腹痛血管源性病因的 CT 资料。结果腹痛的血管源性病变中,肠系膜上动脉及静脉闭塞最多见,共30例(43%),而引起闭塞最常见的原因是血栓形成(27%);各种累及腹主动脉的夹层(Ⅰ+Ⅲ型+局限性)15例;腹主动脉和/或髂总动脉多发溃疡9例(13%);B 型壁内血肿6例(8%);单纯肠系膜上动脉夹层5例;其他较少见的有脾动脉血栓闭塞2例,双肾动脉闭塞及单纯脾动脉夹层各1例。所有病例中漏诊7例,主要原因为放射科医生把关注的重点放在腹腔内容易出现腹痛的实性脏器或空腔脏器,而忽略了观察扫描范围内的腹主动脉及其主要分支动脉,缺乏对这一类病变的认识和经验。结论血管源性病因是导致腹痛的一个重要原因,对于临床以腹痛行 CT 检查的患者,在排除常见的肠道及其他腹腔脏器病因后,应想到血管源性病因的可能,并仔细查找腹腔内的动静脉血管以排除可能的病变。     

Sonography of blunt abdominal trauma (author's transl)

Sonographic examination of the abdomen after blunt abdominal trauma represents a rapid and effective diagnostic method without bothering the patient. It has proved its value not only in the confirmation or exclusion of free fluid in the abdomen caused by liver of spleen rupture, but also in such cases actually it replaces peritoneal lavage or exploratory laparotomy. It is also qualified for diagnosis of intraparenchymal or subcapsular hemorrhages, intraperitoneal as well as retroperitoneal and for follow up. In particular delayed bleedings including the risk of a retarded organ rupture can be detected early. A failure rate of 1.4% in 282 sonographically examined cases of blunt abdominal trauma further confirms the reliability of this method.     

Examination of the injured spleen using computer tomography

In blunt abdominal injury the most frequently injured organ is the spleen. A rapid and precise diagnosis of an injured spleen is therefore of great importance for early and correct therapeutic procedure. The authors present a group of 56 patients, who have been examined in the 1981-1987 years after blunt injuries of the belly by computer tomography. In 12 cases there was the diagnosis of subcapsular haematoma of the spleen, intraparenchymatous rupture was present in eight patients. In the remaining 36 cases the trauma of abdominal organs was not confirmed. All findings were verified by surgery or a control computer tomography and clinical examination of the patients. The authors demonstrate typical traumatic conditions. Computer tomography is a very useful method which enables a rapid, precise and non-invasive diagnosis of different degree of the spleen injury, its possible complications and differentiates these conditions from uninjured spleen. The authors present a brief survey of pictures of injured spleen in other methods of examination. In comparison with those methods, computer tomography is the most effective one, which provides a complex information of other organs of abdominal cavity. It also enables a considerate examination of patients severely injured and in non-cooperating ones.     

外伤性小肠破裂8例延误诊治的原因分析

目的　分析外伤性小肠破裂误诊的原因 ,以吸取教训。方法　对延误诊治的 8例外伤性小肠破裂进行回顾性分析。结果　 5例治愈且无并发症 ,1例腹壁疝形成者腹壁感染延期愈合 ,2例死于ARDS。结论　早期诊断与及时手术是降低小肠破裂病人死亡率的关键。延误诊治者 ,大多是早期体征不明显或只注意其它损伤 ,忽略了腹部体征的观察。     

迟发性脾破裂32例诊治分析

目的 探讨迟发性脾破裂(DRS)的诊断和治疗方法。方法 对1978-1999年间收治的32例DRS进行回顾性分析，比较CT、B超、腹腔灌洗等检查手段在DRS诊断中的作用及不同治疗方法的效果。结果 26例行脾切除术，其中1例因合并脑损伤于脾切术后4d死亡；6例严密观察下保守治疗出院，平均住院18．5d。结论 联合腹腔灌洗可提高腹腔穿刺的阳性率。B超是诊断DRS和对保守治疗患者进行严密观察的重要手段。     

B超对肝脾破裂的诊断准确性

目的:分析肝脾破裂的超声图像表现,通过与手术病理对照,找出漏或误诊原因,从而提高B超在腹部闭合性损伤诊断中的准确性。材料和方法:本文报道了33例闭合性腹部创伤,术前全部经B超检查,探查了肝脾及腹腔情况。结果:33例患者经手术病理证实为肝破裂者7例,B超符合率为85.7％(6/7);脾破裂者26例,B超符合率为92.3％(24/26)。结论 B超对于肝脾破裂的诊断有肯定的临床价值,应作为首选检查。     

Gunshot wounds of the abdomen studied by computed tomography. The authors' personal experience in 30 cases

INTRODUCTION: CT plays an important role in depicting gunshot wounds in parenchymal and hollow organs in the abdomen. Relative to other techniques and to emergency laparotomy, CT permits good assessment of abdominal content, major injuries and changes in other districts, such as chest, pelvis and skull. We investigated the yield and role of CT in diagnosing abdominal gunshot wounds, with their rich and varied radiological signs and associated injuries. MATERIAL AND METHODS: We retrospectively reviewed the findings of 30 patients with abdominal gunshot wounds examined in 4 years at Loreto-Mare Hospital, Naples. All patients were men, age ranging 19-54 years (mean: 35); 6 of them were not from the European Union. Examinations were carried out from diaphragm to pubis with i.v. contrast injection and the CT angiography technique. CT was integrated with chest studies in 6 cases and with skull studies in 5. Subsequent CT follow-ups were necessary in 12 cases submitted to conservative treatment. RESULTS: Liver was the most damaged parenchyma, with hemorrhage and lacerocontusion in 7 cases and mashed in 1 case; spleen was involved in 4 cases; hemoperitoneum was found in 18 cases. Diaphragm was involved in 5 cases and pancreas in 2; gallbladder, stomach and duodenum were involved in 1 case each and jejunum-ileum and colon in 3 and 6 cases, respectively. CT showed renal injury in 3 cases and bladder injury in 2. Eight patients had vertebral gunshot damage. Pneumothorax, hemothorax and lacerocontusion were found in 7 cases; brain was injured in 4 cases and limbs in 16. DISCUSSION AND CONCLUSIONS: Tissue damage extent depends on the speed and kinetic energy the bullet carries into the abdomen. Abdominal radiography shows the bullet and its site, pneumoperitoneum from gastrointestinal perforation, crash bone injuries, vertebral trauma and subcutaneous emphysema. Instead, CT depicts early parenchymal damage and vascular injury and thus becomes a complete and necessary tool for imaging gunshot wounds. CT provides early diagnostic information which help plan emergency treatment and thus decrease mortality. As for angiography and US, we suggest they be used subsequently because in emergency they may delay the diagnosis. Moreover, vessel rupture and active intraabdominal bleeding are easily detected with spiral CT, which appears the best tool for prompt assessment of the injuries associated with gunshot wounds in other districts such as, the skull. To conclude, CT permits adequate planning of emergency surgery and helps select the cases for follow-up, intensive care and conservative treatment.     

外伤性小肠破裂68例诊治体会

目的探讨提高外伤性小肠破裂早期诊断水平和选择合适的治疗方式.方法总结68例因车祸致小肠破裂病例的临床诊断与手术治疗体会.结果本组治愈66例,死亡2例.并发切口感染10例,肠粘连5例,盆腔脓肿1例,肺部感染4例,多器官功能障碍综合征(MODS)2例.结论早期诊断,及时手术,选择合适的手术方式,彻底冲洗和合理的引流,早期应用抗生素,重视整体治疗水平等,可减少并发症(术后感染是其主要并发症)和降低病死率(致死原因主要为小肠瘘和MODS).     

68例腹部交通事故伤的特点及救治

目的 探讨交通事故腹部伤的特点及救治。方法 回顾性分析68例交通事故腹部伤的临床资料。结果 68例均为闭合伤,共涉及101个腹腔脏器损伤,合并腹腔以外脏器严重伤22例,休克28例。腹穿66例,阳性61例。阳性率92．4％。手术治疗62例,非手术治疗6例。治愈61例,死亡7例。结论 交通事故腹部伤的诊断主要依靠病史、体格检查、诊断性腹腔穿刺。及时作出是否剖腹的判断是救治成功的关键。     

CT appearances of abdominal tuberculosis

The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.