胸腹联合伤42例诊治体会  

Experience of diagnosis and treatment for 42 cases with combined thoraco-abdominal injuries

作　　者：陈岩[1] 杨鲁民[1] 毛凯平[2] 杨铁南[2] 王伦青[1] 

机构地区：[1]青岛市人民医院胸外科,山东青岛266001 [2]青岛市市立医院胸外科,山东青岛266011

出　　处：《中国现代医学杂志》2006年第11期1742-1744,共3页China Journal of Modern Medicine

摘　　要：目的总结胸腹联合伤的特征、诊断与治疗方法。方法回顾1990年1月～2004年12月收治的42例胸腹联合伤,其中车祸伤15例,刀刺伤11例,坠落伤7例,挤压伤3例,枪击伤3例,击打伤2例,医源性穿刺伤1例。形成创伤性膈疝18例。合并有血、气胸者32例,休克16例,创伤性湿肺12例。术前确诊33例,误诊9例,误诊率21.4%。40例行手术治疗,其中经左胸切口21例,经右胸切口5例,经双侧胸切口3例,经腹、胸分别切口5例,经腹部切口4例,经胸腹联合切口2例。结果治愈37例,死亡5例,死亡率为11.9%。失血性休克是死亡的主要原因。结论胸腹联合伤病情复杂严重,易误诊,死亡率高,临床应根据病史、体检、X线检查及穿刺引流等做出综合判断,对确诊及高度可疑病例应积极行手术治疗。[Objective] To summrize the characteristics, diagnosis and treatments of combined thoraco-abdominal injuries. [Methodsl A retrospective study was carried out in 42 cases combined thoraco-abdominal traumas from 1990 to 2004, 15 cases among whom were caused by traffic accident, 11 cases were caused by cutter, 7 cases were caused by falling, 3 cases were caused by crushing, 3 cases were caused by shoot, 2 cases were caused by beating, 1 case was caused by puncture in hospital. 18 cases were combined with tranrmatic diaphragmatic hernia, 32 cases were combined with hemopneumothrax, 16 cases were combined with shock, 12 cases were combined with transient tachypnea. 33 cases were surely diagnosed before surgery, 9 cases were misdiagnosed, the ratio was 21.4%. 40 cases were treated by surgery, 21 cases among whom were surgery through left thoracic cavity in the operation, 5 cases were surgery through right thoracic cavity, 3 cases were through bithoracic cavity in the operation, 5 cases were through thoracic cavity and abdomine in the operation, 4 cases were through abdomine, 2 cases were through thoracic-abdonimal incision.[Resutlts] 37 cases were cured, 5 cases were dead, the death rate was 11.9%. The main reason of death was hemorrhagic shock. [Conclusions] Combined thoraco-abdominal injuries were severe and complicated injuries were with high mortality and lead to misdiagnosis easily. Medical history, health examination, X-ray examination, puncture and drainage should be regarded on clinic. The cases who were surely diagnosed and highly suspected shoud be treated by surgery actively.

关 键 词：胸部损伤 腹部损伤 膈肌 诊断 

分 类 号：R655[医药卫生—外科学] R656[医药卫生—临床医学]