腹部闭合伤43例漏诊原因分析
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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.
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.
引文
[1]刘维政.多发伤患者腹部闭合伤的诊断与手术时机探讨[J].海南医学,2016,27(7):1152-1153.
[2]郭兴,张磊,王景彬,等.腹部外加压治疗腹部闭合伤腹腔出血在院外急救中的应用[J].中国急救复苏与灾害医学杂志,2013,8(6):518-519.
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[14]刘桂平.腹部闭合性损伤的诊治体会[J].中国社区医师,2014,30(27):41,43.
[15]林宇捷.以腹部创伤为主严重多发伤的救治体会[J].中国临床医生杂志,2015,43(10):52-53.
[16]高希景.腹部外伤240例急诊救治体会[J].中国社区医师,2016,32(23):34,36.
[17]吴缨,牟洪臻,周会,等.腹部闭合伤患者腹腔不明原因游离液体临床回顾性分析[J].实用医药杂志,2015,32(10):895-898.
[18]刘进.腹部闭合性损伤小肠破裂的临床诊断及手术治疗效果观察[J].中国继续医学教育,2015,7(25):115-116.
[19]程春东,白雪巍,孙备.创伤性胰腺炎研究进展[J].中国实用外科杂志,2016,36(1):58-60.
[20]李轩然,陈平聪,白春宏.16层螺旋CT在腹部闭合伤中的应用[J].中国当代医药,2012,19(9):91-92.
[21]华利勇,张琼.严重腹部闭合伤的诊治探讨[J].中国卫生产业,2014(34):134-135.
[2]郭兴,张磊,王景彬,等.腹部外加压治疗腹部闭合伤腹腔出血在院外急救中的应用[J].中国急救复苏与灾害医学杂志,2013,8(6):518-519.
[3]孙树田.腹部闭合伤72例临床分析[J].中国当代医药,2010,17(27):188.
[4]胡恩本.老年人腹部闭合伤26例诊治体会[J].临床军医杂志,2003,31(6):107-108.
[5]黄科军.腹部闭合性创伤患者的急诊探讨(附76例分析)[J].航空航天医学杂志,2015,26(4):455-456.
[6]邢万库,李世杰,胡占广,等.腹部闭合伤合并颅脑伤22例诊治体会[J].华北国防医药,2002,14(4):266.
[7]马民,翟春霞.损害控制外科在严重多发伤合并休克救治中的应用[J].现代仪器与医疗,2017(5):6-7,10.
[8]王前进,孙强,王礼俊,等.创伤性钝性膈肌破裂35例诊治分析[J].人民军医,2016,59(10):1051-1052.
[9]王松平,袁中旭,刘书先,等.84例外伤性肝破裂诊疗经验分析[J].实用肝脏病杂志,2016,19(3):331-334.
[10]宋世兵,李强,袁炯,等.腹部闭合伤后小肠破裂延误诊断4例分析[J].临床误诊误治,1996,9(2):71.
[11]谢宙宏,赵开学.延迟性腹部脏器破裂的急症诊断浅析[J].世界最新医学信息文摘(连续型电子期刊),2015(28):83,85.
[12]王群,赵富金,沈豪,等.腹部闭合性外伤致小肠损伤的CT早期表现[J].浙江创伤外科,2015,20(6):1240,1241.
[13]张超,张文俊,朱春林,等.基层医院以腹部伤为主的多发伤的救治体会[J].中华全科医学,2013,11(8):1254-1255.
[14]刘桂平.腹部闭合性损伤的诊治体会[J].中国社区医师,2014,30(27):41,43.
[15]林宇捷.以腹部创伤为主严重多发伤的救治体会[J].中国临床医生杂志,2015,43(10):52-53.
[16]高希景.腹部外伤240例急诊救治体会[J].中国社区医师,2016,32(23):34,36.
[17]吴缨,牟洪臻,周会,等.腹部闭合伤患者腹腔不明原因游离液体临床回顾性分析[J].实用医药杂志,2015,32(10):895-898.
[18]刘进.腹部闭合性损伤小肠破裂的临床诊断及手术治疗效果观察[J].中国继续医学教育,2015,7(25):115-116.
[19]程春东,白雪巍,孙备.创伤性胰腺炎研究进展[J].中国实用外科杂志,2016,36(1):58-60.
[20]李轩然,陈平聪,白春宏.16层螺旋CT在腹部闭合伤中的应用[J].中国当代医药,2012,19(9):91-92.
[21]华利勇,张琼.严重腹部闭合伤的诊治探讨[J].中国卫生产业,2014(34):134-135.