92例胸腹联合伤临床分析  

Cinical analysis of thoracoabdominal combined injuries in 92 cases

作　　者：王灿[1] 张平[1] 高云瀚[1] 陈维庭[1] 

机构地区：[1]重庆市急救医疗中心外科,400014

出　　处：《中华创伤杂志》2003年第6期365-367,共3页Chinese Journal of Trauma

基　　金：卫生部科学研究基金资助项目 ( 98-1-2 2 7)

摘　　要：目的　探讨胸腹联合伤的诊断及治疗特点。　方法　总结经手术证实的胸腹联合伤 92例 ,其中开放性损伤 4 1例 (4 4 .5 7% ) ,以锐器刺伤为主 ;闭合性损伤 5 1例 (5 5 .4 3% ) ,以交通伤多见。分析不同原因的损伤类别及不同临床症状与手术方式。　结果　 92例中 ,术前明确有膈肌破裂 4 2例 (4 5 .6 5 % ) ;88例在第一次手术中发现膈肌破裂 ,并予以修补 (95 .6 5 % ) ,4例未探查膈肌而漏诊 (4 .35 % ) ;死亡 13例 (14 .13% )。　结论　胸腹联合伤是一种特殊类型的损伤 ,伤情复杂、严重 ,死亡率高。诊断应根据受伤机制和出血量判断 ,特别注意避免漏诊膈肌损伤。治疗原则为先处理胸部损伤 ,后处理腹内脏器损伤。Objective To explore the characteristics of diagnosis and treatment of thoracoabdominal combined injuries (TCI). Methods A retrospective study was carried out in 92 cases of TCI treated surgically, among whom were 41 cases (44.57%) with penetrating injury caused by sharp instument and 51 (55.43%) with blunt injury. Traffic injury was commonly seen. The injuries due to different causes and their clinical signs as well as operative measures were analyzed. Results Of 92 cases, 42 (45.65%) had diaphragmatic ruptures preoperatively, 88 (95.65%) diaphragmatic rupture was found in the first operation and was repaired; 4 (4.35%) did not receive disgnosis due to neglect of the diaphragm in operation; and 13 (14.13%) died. Conclusions TCI is a special type of multiple trauma with severe and complicated injuries and a high mortality. The diagnosis should be based on the mechanism of trauma and volume of bleeding. In the meantime, special attention should be paid to avoiding the missed diagnosis of diaphragmatic injuries. The treatment principle is thoracic injury first and laparotomy second.

关 键 词：膈肌损伤 临床特点 胸部损伤 腹部损伤 胸腔闭式引流 失血性休克 

分 类 号：R641[医药卫生—外科学]