腹部闭合性损伤136例临床分析

目的:通过对交通事故中患者的腹部损伤的诊断和治疗探讨如何提高抢救成功率的治疗方法。方法:对136例腹部闭合性损伤的患者进行腹部损伤的诊断和死亡原因进行分析。结果:136例患者当中,只有25例患者采取了保守治疗的方式,其他所有患者均采用手术治疗手段。死亡的患者有3例。结论:腹部损伤多为腹部损伤,在腹部损伤的围手术期对患者进行正确处理就可以提高治愈率。手术探查要简捷而且全面,同时还要注意同一器官多出损伤的状况。

Diagnostic accuracy of CT scan in abdominal blunt trauma

Objective： To evaluate the sensitivity and specificity of CT scan findings in patients with blunt abdominal trauma admitted to the university hospital. Methods： All the patients with blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study. In the absence of any clinical manifestations, the patients underwent a diagnostic CT scan. Laparatomy was performed in those with positive CT results. Others were observed for 48 hours and discharged in case no problem was reported; otherwise they underwent laparatomy. Information on patients＇ demographic data, mechanism of trauma, indication for CT scan, CT scan findings, results of laparotomy were gathered. The sensitivity, specificity and accuracy of the CT-scan images in regard with the organ injured were calculated. The sensitivity, specificity and accuracy of the CT scan were calculated in each case. Results： CT scan had the highest sensitivity for detecting the injuries to liver （100%） and spleen （86.6%）. The specificity of the method for detecting retroperitoneal hematoma （100%） and injuries to kidney （93.5%） was higher than other organs. The accuracy of CT images to detect the injuries to spleen, liver, kidney and retroperitoneal hematoma was reported to be 96.1%, 94.4%, 91.6% and 91.6% respectively. Conclusion： The findings of the present study reveal that CT scan could be considered as a good choice, especially for patients with blunt abdominal trauma in teaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.

Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong

Objective： Focused Abdominal Sono graphy for Trauma （FAST） is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma （BAT）. This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre. Methods： This was a retrospective study of BAT pa tients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, ab dominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperi toneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete docu mentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predictive values （PV）, likelihood ratios （LR） and accuracy. Results： FAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients. Conclusion： FAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use.

Analysis of closed abdominal injury in pregnant women

Objective: To explore the characteristics of closed abdominal injury in pregnancy women and its treatment.Methods: The clinical data of 37 pregnancy patients with closed abdominal injury treated in our hospital from June 1993 to June 2003 were collected and analyzed.Results: All the 37 patients were treated with operation. Among them 2 early pregnancy patients with intestinal rupture and 1 patient with retroperitoneal hematoma were treated under laparoscope; in other 34 pregnancy patients laparotomy was performed. Of the 34 patients 8 used cesarean section because premature separation of placenta and enlarged womb interrupted the management of intra-abdominal organ injury. In the 37 patients 33 ( 89.1%) were cured, 4 ( 10.8%) die, postoperative complication rate was 16.2% (6/37). Two patients ( 5.4%) suffered from abdominal cavity infection, 3 ( 8.1%) from pulmonary infection, and 1 ( 2.7%) had multi-organ failure.Conclusions: For pregnancy patients with closed abdominal injury, besides obsteric diseases intra-abdominal injury should be given much attention. Accurate diagnosis and timely treatment can gain the time to save the life of both mother and fetus.

Thoracic spinal trauma associated with closed thoraco-abdominal injury

Objective: To explore the management of thoracic spinal trauma (TST) associated with closed thoraco abdominal injuries (CTAI). Methods: A retrospective study was made on 259 patients with TST admitted to our department as an emergency treatment from January 1996 to June 2001. We summarized the clinical features of TST associated with CTAI. Results: Among 259 patients with thoracic spinal trauma, 112 were associated with CTAI. Traffic accident was the most common cause. The force causing upper TST was more violent than that causing the lower. Pulmonary complications were the leading cause of death in this group. Surgery could not improve neurological function for completely paraplegic patients. Conclusions: The reason that upper TST has the tendency to be associated with CTAI is its special anatomical feature. Routine ultrasonic examination can avoid misdiagnosis of latent closed abdominal injuries associated with spinal injury. The presence of potential injuries, especially CTAI, should be considered when deciding whether or not to perform surgery early.