胸腹联合伤的临床诊断和治疗

Clinical features and management of combined thoracoabdominal injury

目的总结胸腹联合伤的临床特点和早期救治的经验,以期降低病死率。方法回顾性分析1990年5月—2007年5月经手术证实的胸腹联合伤者63例临床资料,其中闭合性损伤34例,穿透性损伤29例;左侧膈肌破裂47例,右侧9例,双侧7例,形成创伤性膈疝24例;合并血气胸63例,休克60例。术前确诊41例。63例均行手术治疗,经左胸手术18例,右侧2例,双侧开胸5例,经胸经腹切口4例,经胸腹切口2例,经腹切口32例。结果治愈56例,死亡7例,病死率为11.1%。失血性休克是死亡的主要原因。结论胸腹联合伤病死率高,最常见的死亡原因是失血性休克;手术入路应视具体伤情而定;及早诊断和及时手术是挽救危重患者生命的关键。

Objective To review the clinical features and early management of combined thoreoabdominal injury （ CTI ） , to decrease the mortality rate. Methods A retrospective study was carried out in 63 cases of CTI treated surgically from May 1990 to May 2007. There were 34 cases with blunt injuries and 29 cases with penetrating injuries. Forty-seven patients had rapture of left diaphragm, 9 cases had rupthure of right diaphragm, 7 cases had rupture of both diaphragms, 24 cases were combined with traumatic diaphragmatic hernia, 63 cases were combined with hemopneumothorax, and 60 cases were combined with shock. Forty-one cases were diagnosed correctly before surgery. Sixty-three cases were treated by surgery, among them, surgery was performed through left thoracotomy in 18 cases, through a right thoracotomy in 2 cases, through bilateral thoracotomy in 5 cases, through thoraco-abdominal incision in 2 cases, and through the abdominal route in 32 cases. Results Fifty-six cases were cured, and 7 cases （ 11.1% ） died. The main cause of death was hemorrhagic shock. Conclusions CTI has high mortality rate, and the most frequent cause of mortality is hemorrhagic shock. The operative approach is based on the individual injury condition. Early diagnosis and timely surgical intervention is the key to improving the cure rate and reducing mortality in severe CTI.