摘要
目的 探讨儿童腹部闭合伤的保守治疗及手术探查的指征和时机。 方法 将我院１９９０ 年１ 月至１９９８ 年１０ 年住院的２１６ 例腹部闭合伤患儿分为肝脏损伤、脾脏损伤、肾脏损伤、胃肠道损伤、胰腺损伤、输尿管损伤、膀胱损伤，并逐一对其进行回顾性分析。 结果 ６５ 例肝损伤，６ 例行剖腹探查；５４ 例脾损伤，８ 例手术，１ 例行脾切除，脾保留９８ ％ （ 未包括２ 例巨脾外伤行脾切除的患儿） ；１８ 例胃肠道损伤，１３ 例手术探查（ 其中５ 例住院后立即手术，８ 例住院２４ 小时后手术） ；６ 例输尿管损伤，均在伤后６ ～２０ 天手术；４ 例膀胱损伤均急诊手术修补；１２ 例胰腺损伤，２ 例手术治疗，１０ 例保守治疗，保守治疗患儿中４ 例伤后４ 周出现假性胰腺囊肿。 结论 （１） 肝损伤保守治疗有一定危险性，输液后，输血超过４０ ｍｌ／ｋｇ ，患儿血压仍不能稳定在正常范围内或出现胆汁性腹膜炎的患儿应手术探查。转氨酶的变化对判断肝损伤严重程度非常有用。（２） 脾损伤患儿输液后输血超过４０ ｍｌ／ｋｇ血压仍不能维持在正常范围内，或巨脾出现脾损伤患儿应手术探查，并应切除巨脾。（３） 胃肠道损伤合并气腹或腹膜炎表现持续加重尤其早期患儿体温明显增高时应手术探查。（
Objective To answer the question that when the children with abdominal blunt trauma should have an operation. Methods This retrospective review included 216 children who had abdominal blunt trauma, due to mainely traffic accidents. The patients enrolled including: hepatic injury, splenic injury, renal injury, gastrointestinal injury, pancreatic injury, ureteral and bladder injuries etc.. Results Of 65 patients with hepatic injury, six underwent surgery.Among 54 children with splenic injury, 8 underwent laparotomy but only one had splenectomy making a splenic salvage rate of 98%. 18 children with gastrointestinal injury underwnet laparotomy. In those 13 children, 5 underwent laparotomy, while 8 underwent surgery 24 hours after admission when severe abdominal rigidity and pneumoperitoneum were discussed. 5 of 57 renal injuries had early operation with six ureteral injuries were operated on 6～20 days after the trauma. 4 patients with bladder injury underwent surgery without delay. Two of 12 patients with pancreatic injuries were operated on with one being operated on six months later because of a pseudocyst. Conclusions Conservative management of hepatic injuries is more hazardous than that of splenic injuries. Operative treatment ought to be carried out when hemodynamic stability could not be maintained despite a continuous intravenous fluids and blood transfusion, or when the total amount of blood transfusion exceeds 40 ml/kg. Patients with bile duct injury should be operated on. Elevated liver transaminase level seems to be a reliable indicator of liver injury. The injuried splenomegaly should be removed. Exploration should be carried out in patients with pneumoperitoneum or abdominal rigidity or high termperature in early stage of gastrointestinal injury. Children with pancreatic injury should undergo conservative treatment in general. IVP examination should be carried out early in children suspected of renal injury.
出处
《中华普通外科杂志》
CSCD
1999年第5期380-383,共4页
Chinese Journal of General Surgery
