目的 总结腹部闭合性损伤的诊治体会。方法 回顾性分析我院78例腹部闭合性损伤患者的临床资料。结果 78例中67例手术治疗，4例行肾动脉栓塞术，7例保守治疗； 除1例死亡外，余均治愈。结论 及时诊断和治疗是救治腹部闭合性损伤患者的关键，腹腔穿刺、B超、CT及X线检查的合理应用对诊断有重要价值。
ObjectiveTo establish pig abdomen bullet wound model in seawater immersion condition and to analyze injury characteristics. MethodsTwenty Xishuangbanna pigs were randomly divided into seawater immersion group and control group,with 10 in each group.The left lower quadrant anti McBurney point of the pig semi-floating in the seawater was shot by using domestic 81-1 assault rifle at the distance of 10 meters,which were salvaged out of seawater at 60 minutes after injury in the seawater immersion group.The pigs in the control group were treated same as the seawater immersion group except seawater immersion.The mean arterial pressure (MAP),rectal temperature (RT),heart rate (HR),respiratory (R),white blood cell count (WBC),and C-reactive protein (CRP) were tested at 1 h,4 h,8 h after injury.The death of pig was observed. ResultsThe pig abdomen bullet wound models in the seawater immersion condition were successfully established.① Compared with the control group,the MAP and RT were significantly decreased at 1 h,4 h,8 h after injury,the HR or the R was significantly decreased at 4 h or 8 h after injury respectively in the seawater immersion group.② Compared with the normal value,the WBC obviously rose at 4 h and 8 h after injury,the CRP obviously rose at 1 h,4 h,and 8 h after injury in both two groups.Compared with the control group,the WBCs were significantly increased at 4 h and 8 h after injury (P<0.05),the CRPs were significantly increased at 1 h,4 h,and 8 h after injury (P<0.05) in the seawater immersion group.③ The mortality in the seawater immersion group (50%) was significantly higher than that in the control group (20%,P<0.05). ConclusionThe injury is more serious,the infection time is earlier,and the infection degree is aggravated,the mortality rate is higher for pig abdomen bullet wound model in seawater immersion condition.
ObjectiveTo explore the diagnostic and therapeutic significance of laparoscopic surgery for abdominal trauma patients. MethodsClinical data of 65 patients with abdominal trauma who treated in Affiliated Laigang Hospital of Taishan Medical College from January 2010 to December 2014 were collected retrospectively, all patients were diagnosed by laparoscopic exploration, and therapies were depended on the results of laparoscopic exploration. ResultsOf the 65 patients, 60 patients were definitely diagnosed through laparoscopic exploration, but 5 patients transferred to laparotomy because of clear diagnosis was not achieved under laparoscopy. Of the 60 patients who were diagnosed clearly by laparoscopy, 23 patients didn't received any intervention because of no obvious injury observed, 27 patients received laparoscopic surgery (3 patients were assisted with hands), and 10 patients transferred to open operation because of peritoneal contamination. Incision infection occurred in 1 patient after operation, 1 patient suffered from subphrenic abscess, and other 63 patients didn't suffered from any complication. All of the patients were discharged successfully. All of the 65 patients were followed up for 2-48 months with the median time of 10 months. Severe complications did not occurred and no patient needed re-operation within the period of follow-up period. ConclusionsLaparoscopy is feasible, safe, and effective for the evaluation and treatment of abdominal trauma patients with stable hemodynamics, and it also has a higher diagnostic rate. Laparoscopy can also reduce the negative exploratory laparotomy for the abdominal trauma patients.
【摘要】 目的 探讨强化益生元膳食纤维的肠内营养在腹部外科术后患者中的临床应用。 方法 2008年7月-2010年11月30例接受腹部外科中等以上手术的患者术前随机分为研究组和对照组，每组15例。研究组患者于术后接受肠内营养，并予以强化益生元膳食纤维；对照组只接受相同的肠内营养支持。观察指标为术后感染并发症、胃肠道并发症、住院时间、抗生素治疗时间、C反应蛋白水平和病死率等。 结果 研究组术后住院时间为（10±5） d，对照组为（15±7） d，两组差异有统计学意义（t=2.251，P=0.033）；研究组C反应蛋白水平为（6.6±3.2） mg/L，对照组为（9.8±2.1） mg/L，两组差异有统计学意义（t=3.238，P=0.003）；研究组抗生素治疗时间为（5.0±3.5） d，对照组为（6.0±4.8） d，两组差异无统计学意义（t=0.652，P=0.520）。两组均无死亡病例；术后研究组2例发生感染并发症，对照组3例，两组感染并发症发生率差异无统计学意义（P=1.000）。两组患者均能耐受经肠内补充营养素。 结论 与常规肠内营养比较，给予强化益生元膳食纤维的肠内营养能减少腹部外科术后患者的住院时间，降低急性期炎症反应。【Abstract】 Objective To investigate the effect of early enteral supply of prebiotic fiber in patients undergoing major abdominal surgery. Methods Between July 2008 and November 2010, 30 patients undergoing major gastrointestinal surgery were randomized into the study group and the control group before operation with 15 patients in each group. Prebiotic fiber was administered combined with enteral nutrition support for patients in the study group. Patients in the control group only received conventional enteral nutrition without fiber. The main endpoints included the development of bacterial infection, the duration of hospital stay, antibiotic therapy, the serum level of C-reaction protein (CRP), side effects of the enteral nutrition and morbidity. Results Compared with the control group, the median duration of hospital stay was shorter in the study group [(15±7) days in the control group vs. (10±5) days in the study group; t=2.251, Plt;0.05]. The mean level of CRP was also lower in the study group [(6.6±3.2) mg/L] than that in the control group [(9.8±2.1) mg/L] (t=3.238, Plt;0.05). The enteral nutrition and fibers were well tolerated. The incidence of infectious complications (3 cases in the control group vs. 2 cases in the study group) and the median duration of antibiotic therapy [(6.0±4.8) days in the control group vs. (5.0±3.5) days in the study group] were not significantly different between the two groups (t=0.652, Pgt;0.05). No patients died in both the two groups. Conclusion Compared with the conventional enteral nutrition, early enteral supply of prebiotic fiber can reduce the duration of hospital stay and acute phase response.
目的探讨腹腔镜在腹部外伤诊断与治疗中的应用价值。方法 对36例腹部外伤患者行腹腔镜探查术，首先明确诊断，根据不同的损伤脏器和类型，进行腹腔镜下处理，处理困难或无效时及时中转开腹。结果本组病例术中均明确诊断。10例开放性腹部外伤中，胃破裂伤2例，肝裂伤2例，脾破裂1例，小肠破裂伤2例，大网膜损伤1例，肠系膜血管破裂1例，单纯腹壁裂伤1例。26例闭合性腹部外伤中，胃破裂2例，肝破裂7例，脾破裂12例，小肠破裂2例，肠系膜血管破裂1例，单纯腹膜后血肿2例。于腹腔镜下行缝合、修补、电凝、明胶海绵止血等治疗20例（55.6%），10例（27.8%）未做特殊处理，6例（16.6%）中转开腹。本组病例术中出血量为55~1 800 ml（平均520 ml），手术时间为60~186 min（平均128 min）。 所有病例均放置腹腔引流2~5 d（平均3 d），住院时间3~16 d（平均9 d）。全组均无气腹相关并发症和死亡病例。结论腹腔镜诊治腹部外伤具有创伤小、诊断率高、恢复快等优点，大部分病例还可在腹腔镜下达到诊治一体化的目的。
Objective To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma. Methods Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected. The injury causes, diagnostic methods, surgical treatment methods, curative effect, and complications of patients were analyzed. Results A total of 8 patients were included. Among them, there were 7 males and 1 female. The age ranged from 17 to 66 years old, with an average of (44.4±19.3) years old. There were 5 cases of traffic accident injury, 2 cases of crush injury, and 1 case of falling injury. There was 1 case of duodenal bulb injury, 3 cases of descending part injury, 3 cases of horizontal part injury and 1 case of both descending and horizontal injuries. According to the scale of American Association for the Surgery of Trauma for duodenal trauma, there were 5 cases of grade Ⅱ injury, 2 cases of grade Ⅲ injury, and 1 case of grade Ⅳ injury. All patients underwent CT scan, of which 2 cases were directly diagnosed with duodenal injuries by CT, and the remaining cases diagnosed by intraoperative exploration. All patients underwent surgical treatment, including 4 cases of pancreaticoduodenectomy, 2 cases of duodenal repair and gastrojejunostomy, 1 case of duodenal repair plus jejunostomy, and 1 case of superior mesenteric vein repair, pancreatic necrotic tissue removal, and abdominal catheterization for smooth drainage. One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery, 1 died of multiple organ failure during the resuscitation phase after damage control surgery, 3 developed intra-abdominal infection and cured by anti-infective treatment. Conclusions Early clinical manifestations of traumatic duodenal injuries are atypical, and imaging findings might not be clear. For trauma patients suspected of having duodenal injury, rigorous vital sign monitoring is necessary. Once vital signs stabilize, exploratory surgery should be actively considered to identify the location of the injury and perform appropriate surgical procedures. Adequate postoperative enteric decompression and drainage should be ensured.
【Abstract】ObjectiveTo generally analyze the current situations of clinical research and applications in early enteral nutrition (EEN) after abdominal surgery. MethodsThe published papers about the current situations of clinical research and applications in EEN after abdominal surgery were reviewed. ResultsEEN after abdominal surgery seems to be safe and effective, produces a positive nitrogen balance, keeps the integrality of structure and function of the apparatus, protects gut barrier, and reduces or prevents septic complications. ConclusionEEN may be of more benefits and will be one of the best methods of nutrition support after abdominal surgery.
ObjectiveTo investigate the clinical features and strategy of diagnosis and treatment of the abdominal trauma in elder people. MethodsClinical data of 68 elderly patients with abdominal trauma were analyzed retrospectively.ResultsDiagnosis in 35 of 68 cases were confirmed within 12 hours after trauma (51.5%). Fiftyeight cases in this group were treated surgically and 10 cases with nonsurgical treament.There were 7 death, the overall mortality was 10.3%. The cause of death was septic shock and multiple organ systemic failure. ConclusionThe elder patient with abdominal trauma has its speciality in clinical and pathophysiological characteristics and is less tolerant to trauma, which easily leads to misdiagnosis or maldiagnosis. The principle of treatment is to choose positive surgery, to streng then the perioperative management, to protect the function of each important organ, and to prevent the occurrence of multiple organ dysfunction syndrome.