腹部钝性损伤出血非手术治疗的病例选择

On the non-operative treatment for bleeding of blunt abdomenal trauma

为了探索腹部钝性损伤出血的非手术治疗指征，总结９７例已诊断为腹腔出血的病例。分为甲乙两组；甲组５２例在Ｂ超及ＣＴ的监测下，密切观察血液动力学变化，１７例非手术治疗成功，３５例手术治疗。乙组４５例，除１例非手术治疗外４４例急诊手术。比较两组非手术治疗率分别为３２７％（１７／５２）和２２％（１／４５）。术前肝脾损伤诊断符合率分别为９５５％（２１／２２）和６２５％（２０／３２）手术单纯探查率分别为５７％（２／３５）和２７３％（１２／４４），以上均有显著差异，认为对于血液动力学稳定，出血量不超过５００ｍｌ。

To explore non-operative treatment of abdomenal blunt trauma,97 patients diagnosed peritoneal bleeding and divided into A and B groups.In A group 17 patients received conservative treatment successfully,laprotomy was performed in 35 patients.In B group(n=45),all received operative treatment except one patient.Nonoperative ratios in A and B groups were 327%(17/52)and 22%(1/45) respectively.Preand postoperative diagnostic accuracy rates were 955%(21/22) and 625%(20/32) respectively in A and B groups.It suggests that non-operative treatment is performed with stable dynamics and bleeding beyond 500 ml,even if injury of liver or spleen is diagnosed.