骨盆骨折并发腹膜后血肿的诊治策略

Diagnosis and treatment strategies of pelvic fracture complicated with retroperitoneal hematoma

目的:探讨骨盆骨折并发腹膜后血肿的诊断与治疗策略。方法:2006年1月~2012年5月,采用中西医结合疗法诊治骨盆骨折并发腹膜后血肿患者51例,男36例,女15例;年龄18~57岁,中位数35岁;受伤至就诊时间30min^5d。合并其他部位骨折21例,肾挫裂伤4例,小肠破裂8例,肝脏破裂4例,脾脏破裂8例。并发症尿道断裂11例,膀胱破裂9例,直肠破裂1例,结肠破裂4例,髂静脉破裂2例。结果:本组治愈46例,死亡5例。死亡原因为多发伤、伤势过重,发生失血性休克及弥漫性血管内凝血,导致多器官功能衰竭。术后并发粘连性肠梗阻5例,经非手术治疗后治愈;并发膀胱阴道瘘1例,盆腔脓肿1例,均经再次手术后治愈。结论:骨盆骨折并发腹膜后血肿是一种严重复杂的外伤,常合并腹盆腔脏器及大血管损伤,而使临床表现多样化,误诊率高,死亡率高。详细询问病史,仔细反复腹部检查,进行诊断性腹腔穿刺,综合运用B超、CT、X线检查,可提高诊断的正确率。尽早明确诊断,尽快纠正休克,积极处理骨盆骨折和合并的脏器损伤,必要时剖腹探查迅速控制出血,是提高抢救成功率的关键,而术中血肿是否探查因血肿部位及动态而异。

Objective: To investigate the diagnosis and treatment strategies of retroperitoneal hematoma complicated with pelvic fracture. Methods:From January 2006 to May 2012, treated 51 patients in the integrative medicine, 36 males and 15 females;aged 18 to 57 years, with a median age of 35 cases;injuries to treatment time 30 minites to 5 days. Combined with other fractures in 21 cases, 4 cases of renal contusion, rupture of small intestine in 8 cases, 4 cases of ruptured liver, spleen rupture in 8 cases. Complicated with urethral rupture in 11 cases, 9 cases of bladder rupture, rupture of one case of rectal, colon rupture in 4 cases, 2 cases of ruptured iliac vein. Results:46 cases were cured, 5 cases died. Postoperative intestinal obstruction in 5 cases, the non-surgical treatment to cure; one case complicated vesicovaginal fistula, one case pelvic abscess, were cured by surgery again. Conclusion:retroperitoneal hematoma complicated pelvic fracture is a serious complication of trauma, often associated with abdominal and pelvic organs and vascular injury, leaving the diverse clinical manifestations, misdiagnosis rate and high mortality. Detailed history, careful repeated abdominal examination, diagnostic paracentesis, the integrated use of B-ultrasound, CT, X-ray examination, may improve the diagnostic accuracy. Early diagnosis, correct shock as soon as possible, and actively deal with pelvic fractures and organ damage combined, if necessary laparotomy rapid control of bleeding, is the key to improve the success rate, and whether exploratory surgery hematoma hematoma due to the location and dynamics vary.