胸腹联合伤的诊断和治疗

Diagnosis and surgical treatment of thoraco-abdominal injuries

目的 :总结胸腹联合伤诊断与外科治疗的临床经验。 方法 :回顾性分析 1 993年 1月至 2 0 0 3年 1月该院收治的 6 7例胸腹联合伤患者的临床资料。 结果 :经胸手术 2 2例 ,经腹手术 33例 ,胸腹联合切口 3例 ,同时做胸部和腹部切口 4例。治愈 5 9例 ,术后发生成人呼吸窘迫综合征 (ARDS) 7例 ,5例经气管切开、机械通气支持 4～ 1 9天后抢救成功。死亡 8例 ,其中 3例死于失血性休克 ,3例死于严重创伤致多器官功能障碍综合征 (MODS) ,2例死于ARDS。 结论 :胸腹联合伤病情危重 ,伤情复杂 ,早期明确诊断与及时正确的围手术期处理是降低病死率、提高治疗效果的关键。

Objective: To summarize the clinical experiences of early diagnosis and surgical treatment of thoraco abdominal injuries. Methods: The clinical materials of 67 patients with thoraco abdominal injuries from January 1993 to January 2003 were reviewed retrospectively. Results: Thoracic explorations, abdominal operations, thoraco abdominal operations, and simultaneous thoracic explorations and abdominal operations were carried out in 22 patients, 33 patients, 3 patients and 4 patients respectively. 59 patients were cured. Among 7 patients complicated with ARDS, 5 underwent tracheotomy with mechanical ventilatory support for 4～19 days. Eight patients died, among which 3 died of hemorrhagic shock from multiple trauma, 3 died of MOF after severe trauma, and 2 patients died of ARDS. Conclusion: Thoraco abdominal injuries are critical illness, it’s important to make an early diagnosis and chose a prompt and proper treatment strategy for the patients.