外科学课件：腹部损伤.ppt

胰腺损伤(Pancreas Injury) 胰腺损伤(Pancreas Injury)—临床特点 胰腺位置深,常为中上腹严重暴力损伤所致 常合并胰周或胰后大血管损伤及胰漏,故死亡率高 腹痛剧烈,可放射至腰背部,伴腹肌紧张和压痛、反跳痛 血、尿淀粉酶增高 B超、CT可见胰腺形态损害改变 胰腺损伤--AAST Organ Injury Scale Grade? Injury Description??????? I Haematoma ? Minor contusion without duct injury???????? ? Laceration ?? Superficial laceration without duct injury?????????II Haematoma Major contusion without duct injury or tissue loss???????? ? Laceration ? Major laceration without duct injury or tissue loss ?III Laceration?? Distal transection or parenchymal injury with duct injury???????? IV Laceration Proximal transection or parenchymal injury involving ampulla? ????????? V ?Laceration Massive disruption of pancreatic head ???Advance one grade for multiple injuries to same organ up to Grade III. Proximal pancreas is to the right of the superior mesenteric vein. 胰腺横断伤 胰腺横断伤 胰腺横断伤 Gunshot wound to pancreatic Head 胰腺枪弹伤 胰腺横断伤 肾脏损伤(Renal Injury) 腰部暴力 多与腹部损伤共存 血尿 腹膜后血肿 ?? ?Grade Injury Description I Contusion Microscopic or gross haematuria, urological studies normal Haematoma Subcapsular, nonexapnding without parenchymal laceration II Haematoma Nonexpanding perirenal haematoma confined to renal retroperitoneum ? Laceration 1cm parenchymal depth of renal cortex without urinary extravasation l????? III Laceration 1cm depth of renal cortex, without collecting system rupture or urinary extravasation l??????? IV Laceration ? Parenchymal laceration extending through the renal cortex, medulla and collecting system Vascular Main renal artery or vein injury with contained haemorrhage