胸腹联合伤109例的早期诊断与救治.docVIP

胸腹联合伤109例的早期诊断与救治 作者:赵成进,管来顺,李彩玲 作者单位：陕西省人民医院急诊外科，陕西 西安 710068 【摘要】 　　目的： 探讨胸腹联合伤(TCI)的诊断及治疗特点. 方法： 总结经手术证实的TCI 109例，其中开放性损伤58例(53.2%)，以锐器伤为主；闭合性损伤51例(46.8%)，以交通伤为主. 分析不同原因TCI的损伤类别及不同临床症状与手术方式，根据受伤机制和出血量进行诊断，注意避免膈肌损伤漏诊. 结果： 在109例中，术前明确有膈肌破裂50例(45.9%)；103例在第1次手术中发现膈肌破裂，并予以修补(94.5%)，6例未探查膈肌而漏诊(5.5%)；死亡15例(13.8%). 结论： TCI伤情复杂严重，死亡率高. 【关键词】 胸部损伤；腹部损伤；膈肌;胸腹联合伤 　　Early diagnosis and emergency treatment of 109 cases of thoracoabdominal combined injuries 　　ZHAO ChengJin, GUAN LaiShun, LI CaiLing, HAN XiWang 　　Department of Emergency Surgery, ShaanXi Provincial Peoples Hospital, Xian 710068, China 　　【Abstract】AIM: To explore the characteristics of diagnosis and treatment of thoracoabdominal combined injuries (TCI). METHODS: A retrospective study was carried out in 109 cases of TCI, among which, there were 58 cases of penetrating injury (53.2%) caused by sharp instrument and 51 cases (46.8%) of blunt injury mainly caused by traffic accident. The injuries due to different causes and their clinical signs as well as operation measures were analyzed. The diagnosis was based on the mechanism of trauma and volume of bleeding. In the meantime, special attention was paid to avoiding the missed diagnosis of diaphragmatic injuries.RESULTS: Of 109 cases, 50 cases(45.9%) had definite Phragmatic ruptures preoperatively; diaphragmatic rupture was found in the first time operation and was repaired in 103 cases (94.5%); 6 cases (5.5%) missed diagnosis due to neglect of the diaphragm in operation; and 15 cases (13.8%) died. CONCLUSION: TCI is a special type of multiple traumas with severe and complicated injuries and a high mortality. 　　【Keywords】 thoracicinjuries; abdominalinjuries; diaphragm; thoracoabdominil combined injury 　　0 引言 　　胸腹联合伤（thoracoabdominil combined injury, TCI）是一种特殊类型的损伤，是由穿透伤或钝性伤导致胸腔及腹腔脏器损伤，同时伴有膈肌损伤. TCI在临床上比较常见，伤情复杂. 现总结我院收治的TCI患者，并对早期诊断和救治方法进行临床讨论. 　　1 对象和方法 　　1.1 对象 　　199410/200610我院共收治经手