腹部闭合伤患者腹腔内不明原因游离液体临床回顾性分析
|
摘要
目的研究腹部闭合伤(closed abdominal injury,CAI)患者腹腔内不明原因游离液体的发生率以及以此诊断腹腔内脏器损伤的价值。方法对笔者所在医院肝胆外科从2002年5月—2012年5月收治的253例腹部闭合伤患者中的34例腹腔内不明原因的游离液体患者的资料进行分析。结果 34例患者CT扫描结果不明原因游离液体少量者10例、中量14例、大量10例;其中14例在伤后2~8h(平均4.61 h)行急诊剖腹探查术,20例入院后首先进行不少于24 h的保守观察治疗,观察组有12例接受了延迟剖腹探查术(观察时间28~72 h,平均35.27 h);26例手术中24例为治疗性剖腹手术,其中19例是空腔脏器损伤,5例是实质性脏器损伤,另外2例为探查性手术;26例手术包括全部24例腹腔内有中量和大量游离液体和2例腹腔内有少量游离液体;延迟手术组中,病死1例(8.3%),6例出现并发症(50.0%);急诊手术组只有1例出现感染,而无病死病例;并且延迟手术组平均住院时间比急诊手术组长(19.21±5.17∶13.42±2.51 d,P<0.01)。结论腹腔内存在不明原因游离液体的腹部闭合伤患者需要接受外科手术治疗的比例高,尤其是存在中量或大量游离液体的患者,大多数存在空腔脏器损伤的可能性大,对于这些患者推荐行急诊剖腹探查术。腹腔内游离液体的量与腹腔内脏器损伤之间明显相关。
Objective To analyze the incidence of unexplained free fluid in CAI patients and its diagnostic value for abdominal organ injury. Methods The data of 253 patients with CAI who had been treated in author's hospital(hepatobiliary surgical department) from May 2002 to May 2012 were reviewed. Results Among 253 cases219 had definite diagnosis and underwent timely surgical management;Only 34 cases(13.40%) of the 253 had different amount unexplained intra-abdominal free fluid but without free air or definite organ injury showed on abdominal computed tomography. They met the inclusion criteria. Their clinical management and operative findings were followed as the volume of free fluid was graded into trace(10 / 34),moderate(14 / 34) and large(10 / 34);14underwent an emergency laparotomy after injury(mean 4.61 h,range 2 to 8 h). The rest 20 were observed for at least 24 hours,and 12 of them underwent delayed operation after varying periods of observation(mean 41 h,range25 to 96 h);24 underwent therapeutic laparotomy:19 of the 24 patients suffered from a hollow organ injury,5from solid organ injury. Rest 2 patients received laparotomy nontherapeutic. The patients who underwent laparotomy included 24 cases with moderate or large amounts of free fluid and 2 cases with trace amount of free fluid. The complications in the delayed operation group included 1 being death and 6 being of infection;in the emergency operation group there had no died case but 1 of infection,and the mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group(19.21 ±5.17 vs 13.42 ±2.51 d,P <0.01).Conclusion The proportion of CAI patients with unexplained intra-abdominal free fluid who required surgical intervention is high,particularly those with a moderate or large amount of free fluid,and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients. There is a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury.
Objective To analyze the incidence of unexplained free fluid in CAI patients and its diagnostic value for abdominal organ injury. Methods The data of 253 patients with CAI who had been treated in author's hospital(hepatobiliary surgical department) from May 2002 to May 2012 were reviewed. Results Among 253 cases219 had definite diagnosis and underwent timely surgical management;Only 34 cases(13.40%) of the 253 had different amount unexplained intra-abdominal free fluid but without free air or definite organ injury showed on abdominal computed tomography. They met the inclusion criteria. Their clinical management and operative findings were followed as the volume of free fluid was graded into trace(10 / 34),moderate(14 / 34) and large(10 / 34);14underwent an emergency laparotomy after injury(mean 4.61 h,range 2 to 8 h). The rest 20 were observed for at least 24 hours,and 12 of them underwent delayed operation after varying periods of observation(mean 41 h,range25 to 96 h);24 underwent therapeutic laparotomy:19 of the 24 patients suffered from a hollow organ injury,5from solid organ injury. Rest 2 patients received laparotomy nontherapeutic. The patients who underwent laparotomy included 24 cases with moderate or large amounts of free fluid and 2 cases with trace amount of free fluid. The complications in the delayed operation group included 1 being death and 6 being of infection;in the emergency operation group there had no died case but 1 of infection,and the mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group(19.21 ±5.17 vs 13.42 ±2.51 d,P <0.01).Conclusion The proportion of CAI patients with unexplained intra-abdominal free fluid who required surgical intervention is high,particularly those with a moderate or large amount of free fluid,and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients. There is a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury.
引文
[1]Ng AK,Simons RK,Torreggiani WC,et al.Intra-abdominal free fluid without solid organ injury in blunt abdominal trauma:an indication for laparotomy[J].J Trauma,2002,52(10):1134-1140.
[2]Ven katesh KR,Mc Quay N Jr.Outcomes of management in stable children with intra-abdominal free fluid without solid organ injury after blunt abdominal injury[J].J Trauma,2007,62(2):216-220.
[3]Brasel KJ,Olson CJ,Stafford RE,et al.Incidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma[J].J Trauma,1998,44(8):889-892.
[4]吴孟超,吴在德.黄家驷外科学[M].第7版.北京:人民卫生出版社,2008:1319-1320.
[5]Sivit CJ.Imaging children with abdominal trauma[J].AJR Am J Roentgenol,2009,192(10):1179-1189.
[6]Bixby SD,Callahan MJ,Taylor GA.Imaging in pediatric blunt abdominal trauma[J].Semin Roentgenol,2008,43(1):72-82.
[7]Livingston DH,Lavery RF,Passannante MR,et al.Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy[J].Am J Surg,2001,182(1):6-9.
[2]Ven katesh KR,Mc Quay N Jr.Outcomes of management in stable children with intra-abdominal free fluid without solid organ injury after blunt abdominal injury[J].J Trauma,2007,62(2):216-220.
[3]Brasel KJ,Olson CJ,Stafford RE,et al.Incidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma[J].J Trauma,1998,44(8):889-892.
[4]吴孟超,吴在德.黄家驷外科学[M].第7版.北京:人民卫生出版社,2008:1319-1320.
[5]Sivit CJ.Imaging children with abdominal trauma[J].AJR Am J Roentgenol,2009,192(10):1179-1189.
[6]Bixby SD,Callahan MJ,Taylor GA.Imaging in pediatric blunt abdominal trauma[J].Semin Roentgenol,2008,43(1):72-82.
[7]Livingston DH,Lavery RF,Passannante MR,et al.Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy[J].Am J Surg,2001,182(1):6-9.