胸腹联合伤32例诊治分析

Thoraco-abdominal combined injuries : Clinical analysis of 32 cases

目的:探讨胸腹联合伤的诊断及治疗特点。方法:总结经手术证实的胸腹联合伤32例,其中开放性损伤15例(46.87%),以锐器刺伤为主;闭合性损伤17例(53.13%),以交通伤多见。分析不同原因的损伤类别及不同临床症状与手术方式。结果:本组32例中存活30例,死亡2例,病死率6.25%,死亡原因:1例为ARDS,1例为肝静脉断裂出血。结论:胸腹联合伤是一种特殊类型的损伤,伤情复杂、严重,死亡率高。诊断应根据受伤机制和特点判断,特别注意避免漏诊膈肌损伤。治疗原则为“先全身后局部,先救命后治病;先处理胸部伤,后处理腹部伤”。

Objective： To explore the diagnosis and treatment of thoraeo-abdominal combined injuries （TCI）. Methods ： A retrospective study was carried out in 32 cases of TCI treated surgically,among which were 15 cases （46. 87%）of open injury mainly caused by sharp instruments and 17（53.13 %） of closed injury commonly seen in traffic injury. The injuries due to different causes and their clinical signs as well as operative measures were analyzed . Results： Of 32 cases, 30 surivived by surgical treatment, and two died due to neglect of the treatment of adult respiratory distress syndrome （ARDS） as well as bleeding of the ruptured hepatic vein. Conclusion： TCI is a special type of multiple trauma with its severity and corfiplicated traumatic condition and a higher mortality. The diagnosis should be paid to the avoidance of the missed diagnosis of diaphragmatic muscle injuries. The treatment principle is thoracic injury first and laparotomy second.