ObjectiveTo investigate the clinical features and strategy of diagnosis and treatment of the abdominal trauma in elder people. MethodsClinical data of 68 elderly patients with abdominal trauma were analyzed retrospectively.ResultsDiagnosis in 35 of 68 cases were confirmed within 12 hours after trauma (51.5%). Fiftyeight cases in this group were treated surgically and 10 cases with nonsurgical treament.There were 7 death, the overall mortality was 10.3%. The cause of death was septic shock and multiple organ systemic failure. ConclusionThe elder patient with abdominal trauma has its speciality in clinical and pathophysiological characteristics and is less tolerant to trauma, which easily leads to misdiagnosis or maldiagnosis. The principle of treatment is to choose positive surgery, to streng then the perioperative management, to protect the function of each important organ, and to prevent the occurrence of multiple organ dysfunction syndrome.
Forty-five pancreatoduodenectomies had been performed in our hospital from 1981 to 1994, of which 35 cases were diagnosed as carcinomas of Vater’s ampulla or pancreatic head, and 10 (cases) as benign lesions. Through analysis of misdiagnosed cases, the authors emphasize that it is important to take correct history of jaundiced patients in detail according to the character of the jaundice and associated symptoms before any operation done. Secondly, all clinical materials must be thoroughly collected and special examinations for diagnosis should be chosen scientifically to avoid relying only on one sort of examination result as diagnostic standard. Thirdly, during operation the area of pancreatic head should be explored carefully and any lesions in doubt should be examined pathologically by puncture biopsy and frozen section to avoid misdiagnosis and thus performing pancreatoduodenectomy.
To evaluate the process from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS) and probe the therapeutic strategies for elderly patients, we retrospectively studied the clinical data of SIRS and MODS in 292 elderly patients with surgical abdominal emergency. Results: On admission, the morbidity rate of SIRS was 41.1%. Afterwards the morbidity rate of MODS was 14.2%, and the mortality rate of the elderly patients with SIRS was 11.7%. After 48 hours of therapy, MODS was developed in 40.5% of the cases also with SIRS. Of all the 292 elderly patients, 19 cases (6.5%) developed MODS and 16 patients (84.2%) died. Conclusion: The outcome of the patients with surgical abdominal emergency may be improved if SIRS is early diagnosed, the cause of SIRS after 48 hours therapy is well defined and the body inflammatory response is properly regulated.
【摘要】 目的 探讨腹部闭合性损伤的外科急救方法。方法 2003年1月—2009年1月收治200例腹部闭合性损伤患者,根据病史、体征、辅助检查等做出诊断后,在确保重要器官血流供应的基础上进行外科手术治疗。结果 治愈187例,治愈率93.5％；死亡13例,9例患者死于多脏器受损引起的出血性休克,2例脾破裂患者因失血过多术中死亡,2例患者因合并颅脑损伤形成脑疝死亡。结论 对于腹部闭合性损伤患者,应快速准确地根据病史、体征、辅助检查等做出诊断,进行积极外科急救治疗。有效控制出血,保证重要器官血液供应,是外科急救能否成功的关键。
Objective To analyze the outcome of patients with Blunt Abdominal Injury (BAI) in the Deyang People’s Hospital after the Wenchuan Earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of BAI patients. Methods Data on the BAI patients within 1 week after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 23 BAI inpatients were treated, of whom 15 were from Mianzhu City and sent to hospital within 12 hours of the earthquake. This was 1.9% of the total inpatients. The BAI inpatients suffered severe and complex injuries, and 5 of them died (mortality rate: 22%). Linenectomy was conducted for patients with spleen injuries and two inpatients developed incision infection due to lack of antibiotics during the perioperative period. Conclusions It is important to establish an emergency response mechanism for medical rescue for patients with the viscera injury, including BAI, after an earthquake. This would help to guarantee rational allocation of the rescue workers, triage of the wounded, optimization of operation, as well as a reduction in mortality from BAI.
【摘要】目的 探讨腹部手术后功能性胃排空障碍的营养支持。方法 对我院1997年1月至2004年2月收治的27例腹部手术后胃排空障碍患者的临床资料进行回顾性分析。结果 单纯肠内营养支持8例（29.6%），肠内、肠外联合营养支持10例（37.0%），单纯肠外营养支持9例（33.3%），分别于术后平均15、20及23 d恢复胃动力。结论 肠内营养在功能性胃排空障碍的治疗中具有重要作用。
目的:分析汶川8.0级大地震致腹部外伤的患者的心理问题并探索其护理对策。方法:以汶川8.0级大地震致腹部外伤的19名患者为暴露组,普通患者20名和医务人员19名作为对照组。由3名医护人员运用汉密顿抑郁量表进行调查和分析。结果:地震伤员在睡眠质量、精神焦虑、抑郁情绪等3个方面与普通患者及医务人员比较有明显异常。结论:地震致腹部外伤患者的心理影响明显大于普通患者及医务人员,应进行及时有效的心理干预护理,以控制和减缓其心理问题。
Objective To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients’ data were retrospectively analyzed. Results There were postoperative complications after skin-sparing mastectomy and immediate breast reconstruction， including TRAM flat necrosis in 1 case， papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients’ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases， part satisfaction in 4 cases， and dissatisfaction in 1 case， respectively. Conclusions Because of the minimal access approach and good breast shape， the skin-sparing mastectomy and immediate TRAM flat breast reconstruction is a safe and effective way for treating early-stage breast cancer.
ObjectiveTo investigate the role of somatostatin in gastrointestinal function after operation for treatment of abdominal injury patients. MethodsSixty patients with abdominal trauma were divided into somatostatin in treatment group (n=30) and the conventional treatment control group (n=30). The amount of gastrointestinal decompression drainage, bowel sounds recovery time, exhaust time, defecation time, and the levels of serum C reactive protein, TNF-α, IL-6, and IL-8 after operation in two groups were observed. ResultsSomatostatin treatment group recovery time of bowel sounds, exhaust time, and defecation time were earlier than the control group, hospitalization time shortened, and the amount of gastrointestinal decompression drainage reduced (P < 0.05), The levels of serum C reactive protein, TNF-α, IL-6 and IL-8 of somatostatin treatment group were lower than those in control group (P < 0.05), and the magnitude of decline above index in the somatostatin treatment group were greater than that in the control group (P < 0.05). ConclusionSomatostatin can promote the recovery of gastrointestinal function in patients after operation in abdominal injury.