腹部闭合伤43例漏诊原因分析  

Analysis of 43 Cases of Missed Diagnosis of Closed Abdominal Injury

作　　者：曹晓凯 范利斌 康剑锋 王帅 CAO Xiao-kai;FAN Li-bin;KANG Jian-feng;WANG Shuai(Emergency Department,Hebei Armed Police Corps Hospital,Shijiazhuang 050081,China)

机构地区：[1]武警河北总队医院急诊科,石家庄050081

出　　处：《临床误诊误治》2018年第4期25-27,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨腹部闭合伤的临床特点和漏诊原因,以提高创伤救治水平。方法回顾性分析我院急诊科2013年1月—2017年7月收治的43例腹部闭合伤患者的临床资料。结果 43例均为多发伤,均在急诊科漏诊腹腔脏器损伤。28例(65.1%)在对已明确损伤脏器进行急诊手术中发现合并其他腹腔脏器损伤;7例(16.3%)复查影像学发现腹腔脏器损伤;6例(14.0%)保守治疗无效患者手术探查发现腹腔脏器损伤;1例(2.3%)二次手术探查时发现新的腹腔脏器损伤;1例(2.3%)在尸检中发现合并其他腹腔脏器损伤。除1例死亡病例,余患者发现新的腹部脏器损伤后,40例(93.0%)予相应外科手术治疗,2例(4.7%)予保守治疗,均痊愈出院。结论腹部闭合伤在多发伤中常见,病理生理因素导致其容易漏误诊。故对多发伤患者应行腹腔脏器常规检查,严密观察病情变化,充分利用合理的检查手段,最大限度避免漏误诊。Objective To investigate the clinical characteristics of abdominal closed injury and reasons for missed diagnosis.Methods The clinical data of 43 patients with closed abdominal injury admitted to Emergency Department in our hospital from January 2013 to July 2017 were analyzed retrospectively.Results All 43 cases had multiple injuries,however,abdominal organ injury was missed in Emergency Department.Twenty-eight cases(65.1%)were found to be complicated with other abdominal organ injuries in emergency operation;seven cases(16.3%)showed abdominal organ injury after imaging examination.Six patients(14.0%)with ineffective conservative treatment experienced abdominal organ injury after surgical exploration.One case(2.3%)had new abdominal organ injury during the second operation and one case(2.3%)was found with other abdominal organ injuries in autopsy.Apart from one reported death,40 cases(93.0%)underwent corresponding surgery and 2 cases(4.7%)were treated conservatively after a new abdominal organ injury was found.All patients were discharged home after recovery.Conclusion Closed abdominal injuries are common in multiple injuries,however,physiological factors generally lead to misdiagnosis and missed diagnosis.Therefore,for the patients with multiple injuries,routine examination of abdominal organ damage is highly recommended.Furthermore,we should closely observe the changes of illness,and make full use of reasonable inspection measures,thereby avoid missed diagnosis and misdiagnosis to the greatest extent.

关 键 词：腹部损伤 创伤和损伤 多处创伤 脾破裂 漏诊 

分 类 号：R826.65[医药卫生—临床医学]