以腹部创伤为主的多发伤218例临床分析

The Clinical Study on the Treatment of 218 Patients with Multiple-traumas of Abdominal Injury

目的：总结以腹部创伤为主的多发伤的临床特点、诊治经验。方法：对218例以腹部创伤为主的多发伤患者进行回顾性分析,损伤腹部脏器以多脏器损伤多见,脾脏挫裂伤69例,肝脏挫裂63例,胃挫裂伤或外伤破裂5例,小肠挫裂或断离伤31例,肾脏挫裂伤24例,膀胱挫裂伤15例,等。结果：诊断性腹腔穿刺、CT和B超检查的阳性率分别为96.2%,82.1%,94.6%;手术治疗191例（治愈178例,死亡13例,死亡的病人主要是严重腹部损伤、多脏器损伤、腹腔大出血、失血性休克合并严重胸部创伤、重型颅脑损伤、多发性骨折等病情）,27例保守治愈出院（肝脏Ⅰ~Ⅱ级挫裂伤,脾脏轻、中度挫裂伤,肾脏挫伤或轻度挫裂伤）。结论：仔细体格检查,诊断性腹部穿刺、B超和CT检查诊断腹部创伤的主要措施,手术应根据伤情轻重缓急,首先处理危及生命的严重损伤。腹腔探查应全面细致,不忽略隐蔽性损伤。

Objective To sum up the clinical characteristics of the patients with multiple-traumas of the abdominal injury and experiences of the treatment.Methods The clinical data of 218 patients with multiple -traumas of the abdominal injury were studied retrospectively.69 cases of splenic contusion,63 patients with liver laceration,5 cases of contusion or traumatic rupture of the stomach,the laceration of small intestine injury in 31 cases,24 cases of kidney contusion,laceration of bladder in 15 cases,and so on.Results Diagnostic abdominal puncture,CT and B ultrasound positive rate was 96.2%,82.1%,94.6% respectivily;191 cases had operative treatment （178 cases were cured,the mortality rate was 6.8% [13/191] ）,27 cases were treated conservatively and discharged.Conclusion Careful physical examination,diagnostic abdominal puncture,B ultrasound and CT diagnosis were main method for the diagnosis of abdominal trauma.Surgery should be based on injury priorities,first of all was to deal with life-threatening serious injury.Comprehensive and careful abdominal exploration should be given to not ignore the hidden injury.