腹部创伤1076例临床分析

Clinical Analysis on 1076 Cases of Abdominal Trauma

【目的】提高腹部创伤及合并伤的早期诊断和手术治疗水平。【方法】回顾分析2001年1月至2008年12月收治的严重腹部创伤1076例的临床资料。其中闭合伤893例（83．0％），开放伤183例（17．0％）；手术治疗969例；腹内主要脏器损伤依次是脾、肝、胃、小肠、肾、结肠等。【结果】全组存活1040例（96．7％），入院时血压为零被抢救成功114例，因手术并发症再次手术17例；死亡36例（3．3％），多死于失血性休克。【结论】在严重腹部创伤时，耗时的诊断程序是不允许的，只有当病人血流动力学稳定时才可作必要的检查以避免遗漏多脏器伤；同时应积极手术，手术止血被认为是最根本的抗休克措施；多脏器损伤处理坚持“保全生命第一，保全器官第二”的手术原则。

[Objective] To explore the early diagnosis and surgical treatment of abdominal trauma and other complicated injuries. [Methods]From January 2001 to December 2008, the clinical data of 1076 cases of severe abdominal trauma including 893 cases of closed injury （83.0%） and 183 cases of open wounds （17.0%） were analyzed retrospectively. Among all patients, 969 cases underwent operation. The main injured organs in abdomen were spleen, liver, stomach, small intestine, colon and kidney, etc. [Results] In the group, 1040 cases （96.70/oo） survived with 114 cases of successful rescue whose blood pressure was zero on admission. Seventy cases underwent reoperation because of surgical complications. Thirty six cases （3.3%） died of hemorrhagic shock. [Conclusion] In severe abdominal trauma, the time-consuming diagnostic procedures are not allowed. Only when the patient＇s hemodynamic condition keeps stable, the necessary examination should be carried to prevent the omission of multi-organ trauma, meanwhile active surgery should be implemented. Surgical hemostasis is considered as the most fundamental anti-shock measures. The management of multiple organ injury should keep the surgical principle i.e. ＂preserving life firstly, and then preserving organs＂.