Search

DIAGNOSIS AND MANAGEMENT OF 168 CASES OF CLOSED HEPATIC TRAUMA

目的探讨诊治闭合性肝外伤的有效方法。方法回顾分析了1990～2000年收治的168例闭合性肝外伤的临床资料。结果均行腹腔穿刺，阳性率为94.6%（159/168），B超检查92例，阳性率为95.7%（88/92），CT检查33例，阳性率为93.9%（31/33），术前确诊率为98.2%。168例中，行非手术治疗37例（22.0%），手术治疗131例（78.0%）。治愈161例（95.8%），其中非手术治疗37例均痊愈； 手术治疗131例中痊愈124例，死亡7例（4.2%）。结论外伤史、体征、腹腔穿刺、B超和CT检查是诊断肝外伤的重要依据，及时手术治疗是降低严重肝外伤病死率的关键。

OPERATION OF RETAINING SPLEEN FOR SPLEEN TRAUMA (REPORT OF 77 CASES)

目的 探讨外伤性脾破裂手术适应证和方法。方法 对77例外伤性脾破裂进行保脾手术治疗，按姜洪池脾损伤四级分类法： Ⅰ级8例，Ⅱ级41例，Ⅲ级18例，Ⅳ级10例。附加脾动脉结扎术6例。结果 死亡4例； 2例并粘连性肠梗阻。获随访45例，随访时间3个月至3年，仅4例儿童有反复上呼吸道感染，无1例发生脾切除后凶险感染(OPSI)。结论 根据脾损伤的部位和程度，可采用两种以上的联合保脾术式，对控制伤脾出血及保留脾脏功能有重要价值。

脑外伤合并截肢1例报道及康复体会

目的：探讨早期康复介入对脑外伤重症患者疗效的影响；方法：对该重症脑外伤患者实施早期综合康复介入治疗；结果：患者肢体及认知功能得到极大的提高，出院时达到了安装假肢步行出院的目标；结论：早期康复介入治疗对改善重症脑外伤患者肢体及认知等各方面功能均有很大疗效，可使患者更高更好更快的回归社会。

The clinical feature, prognosis and prognostic factors of early post-traumatic seizures in children

ObjectiveTo investigate the clinical feature, prognosis and prognostic factors of early post-traumatic seizures in children. MethodsRetrospective review was performed on 101 individuals with early post-traumatic seizures (EPTS) who were diagnosed in Department of Neurosurgery in Children's Hospital of Chongqing Medical University from January 2008 to June 2013. The record was collected, which included patient's demographics, clinical and radiological presentation, management, and follow-up results of 12 months. The individuals were divided into late post-traumatic seizures (LPTS) group and control group according to the occurrence of LPTS or not. The SAS 9.2 was used for statistical analysis. ResultsDuring 101 cases in our study, male accounted for 60.4%, female accounted for 39.6%, and the ratio was 1.5 to 1. The percentage of patients who were under 6 years old was 74.3%, and the number of cases decreased with age. The peak time of EPTS was within 24 hours after traumatic brain injury. 55.4% of EPTS was the generalized seizures, 34.7% was the partial seizures, and 9.9% was the partial seizures and evolved to secondarily generalized seizures. The incidence of LPTS observed in our study was 26.7% within 12 months follow-up. The electroencephalogram displayed epileptiform discharges in 3 individuals who were without epileptic seizures. There was statistically significant difference in group LPTS compared to control group on these factors which included GSC score≤8(P=0.0064), complicated necrencephalus and/or encephalatrophy(P < 0.0001), multiple brain injuries(P=0.0210), subdural hemorrhage(P=0.0151) and intracranial operation(P=0.0029). The age, history, epileptic seizure type of EPTS, brain contusion, skull fracture and the early use of antiepileptic drugs (AEDs) had no statistically significant difference between LPTS group and control group(P > 0.05). ConclusionsEPTS is prone to occur in children under 6 years old. Male is obviously more than female, and the ratio is 1.5:1. The peak time of EPTS is within 24 hours after traumatic brain injury and most of EPTS are generalized seizures. The incidence of LPTS in children with EPTS exceeds those previously reported. Periodical electroencephalogram examination is essential to decrease the missed diagnosis of LPTS. The GSC score≤8 and complicated necrencephalus and/or encephalatrophy will dramaticlly increase the risk of LPTS. Multiple brain injuries, subdural hemorrhage and intracranial operation are also risk factors for the prognosis of EPTS. Although the use of AEDs is unable to decrease the incidence of LPTS after 12 months follow-up, it is probably beneficial to improving the cognition and brain development. The controversial finding in our study is whether intracranial operation can influence the prognosis of EPTS or not.

SIMULTANEOUS LIGATION OF SPLENIC ARTERY AND VEIN FOR SEVERE TRAUMATIC RUPTURE OF SPLEEN

In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.

外伤性脉络膜上腔出血合并视网膜脱离的玻璃体视网膜手术治疗

THE DRAGNOSIS AND TREATMENT FOR DUODENUM RUPTURE IN CHILDREN (REPORT OF 8 CASES)

目的 探讨小儿十二指肠不同程度外伤性破裂的临床表现及治疗方法。方法 对我院1994~1998年收治的8例十二指肠损伤患儿的临床资料进行回顾性分析。结果 ①全部患儿均有上腹部外伤史； ②大多数破裂处位于十二指肠第三段； ③单纯缝合修补加近端十二指肠隧道式造瘘术是有效的治疗方法。结论 小儿十二指肠外伤性破裂以十二指肠第三段为主，单纯缝合修补加近端十二指肠隧道式造瘘术是简单易行的手术方法。

癫痫的一级预防：一项来自国际抗癫痫联盟预防工作组的报告

目前导致癫痫的病因中，有些是可以预防的。该综述总结了由此类可预防病因所造成的癫痫的公共卫生负担，并提出了癫痫一级预防的重要性。系统性回顾针对癫痫的 4 种可预防病因的流行病学研究，这些可预防病因分别是围产期损伤、脑外伤、中枢神经系统感染和卒中。通过使用统一的标准，对每项研究进行质量评估，并从满足质量评级标准的研究中提取了相关风险度量的数据，并将这些结果以中位数和四分位数的方式汇总。高质量的基于人群的研究结果显示，在中低收入国家中，所有年龄段的癫痫患病率约为 1.11%，而在高收入国家中约为 0.7%。围产期脑损伤是儿童癫痫中最常见的可预防病因，在中低收入国家中占 17%，在高收入国家中占 15%。在中低收入和高收入国家中，卒中均是老年癫痫患者中最常见的可预防病因，占所有新发癫痫病例的半数及以上，在高收入和中低收入国家中约 5%癫痫是由卒中造成的。在中低收入国家，中枢神经系统感染是较常见的癫痫病因，约占所有癫痫病例的 5%。在一些低收入农村地区和中等收入国家社区中，地方性神经囊虫病所致癫痫占所有癫痫病例的 34%。可预防的病因所致癫痫占癫痫的总体公共卫生负担的很大一部分。在中低收入和高收入国家中，围产期损伤、感染、脑外伤和卒中所致癫痫占所有癫痫的 25%。母婴保健、免疫接种、公共卫生、预防脑损伤和卒中这些公共卫生干预措施有可能会显著减少癫痫负担。

常规胸部X线片和CT扫描对驾驶员胸部外伤的诊断价值

目的　总结常规胸部X线片和CT扫描对驾驶员胸部外伤的诊断价值，寻找伤情轻重的直接原因。 方法　回顾性分析2006年1月－2011年10月收治的85例因车祸至胸部外伤的驾驶员的临床资料，均采用X线片和CT扫描进行检查，并研究分析其影像学特征。 结果　85例患者中，均有皮肤软组织挫伤，不同程度肋骨骨折65例，肺损伤并血气胸48例，皮下气肿42例，胸膜伤24例，创伤湿肺22例，纵隔外伤18例，肺不张15例；伴发脑损伤32例，椎体骨折23例。在肋骨骨折的诊断上，X线片可较好地反映肋骨骨折数目及错位情况，与CT扫描比较，检出率高；另一方面，CT扫描对肺损伤的诊断较X线片具有较大优势。 结论　X线片与CT扫描在胸部外伤的检查中可以取长补短，二者结合诊断能有效地降低疾病漏诊率。

Interventional Therapies for Patients with Complications of Hemobilia and Biliary Fistula after Operation of Liver Trauma

目的探讨介入治疗在肝外伤术后胆道出血和胆瘘并发症中的作用。方法6例肝外伤术后胆道并发症（胆道出血1例，胆瘘3例，胆道出血合并胆瘘2例）采用介入治疗。胆道出血行肝动脉出血分支血管栓塞，胆瘘采用B超引导下穿刺置管引流。结果3 例胆道出血（肝动脉出血）血管成功栓塞，随访3~6个月未再发生出血。5例胆瘘行B超引导下穿刺置管引流，3例引流3~4周痊愈，1例因引流效果差改手术置管引流6周痊愈，1例伴脓肿者手术置管引流2个半月痊愈。结论介入治疗是处理胆道出血和胆瘘并发症的有效措施。