火器性腹部间接损伤的早期诊断和治疗

On The Principle of Diagnosis and Management of Abdominal Extra-Wound Tract Firearms Injury

腹部火器伤可发生伤道外间接脏器损伤,其发生率为52%,约2/3可在严密观察下保守治疗,必要时剖腹。闭合性腹部火器伤其发生率为23%,一般不需手术。腹腔镜检查是腹部火器伤早期诊断的有益手段。荧光紫外显示法对判断损伤界限有一定参考作用,实质性脏器损伤范围病理变化超过肉眼的正常界限,处理时要注意。有浆膜破损的肠壁血肿应予以修补,预防穿孔。大于1cm的肠壁血肿修补是有益的。

There were indirect injuries of the abdominal organs outside the wound tract in abdominal firearms wounds. This experiment prepared gunshot wound models producing penetrative or tangential wounds of abdominal wall with peritoneum unbroken and peritoneul tangential wounds with only one hole at the peritoneum. The indirect injuries of organs were found in 520% of animals, about 2/3 of which might be treated conservatively under strict observation, and be treated throush laparotomy when neccesary. The injury rate of organs was 23%. The injuries did not need to be treated surgically. Peritoneoscopy seemed to be desirable methods for early diagnosis of abdominal firearms injury. The result of fluorography had referential significance for determination of ranges and distance of injury. The patholosical chanses of injury of parenchymal organs observed with microscopy were larser than those with nakedcye obervation, and should be taken care of intensively throughout the whole process of treatment. Hematoma of intestinal wall with serose broken should be repaired to prevent intestinal perforation. Reparation of hematoma of intestinal wall seemed to be beneficial when the diameter of hematoma was larger than 1.0cm.