132casesofbluntliverinjuryclinicAnalysis-畢業(yè)論文翻譯

1、132 cases of blunt liver injury clinic AnalysisThe liver is one of the most vulnerable Visceral abdominal injury, liver trauma, has more than rupture ofranks first 1. Liver trauma often large amount of bleeding,rapid progression of the disease and high mortality. Therefore, timely diagnosis and trea

2、tment to reducecomplications and mortality is critical article on the hospital in 2010, 1995, admitted 132 cases of blunt liverinjury are summarized as follows:1Clinicaldata1.1GeneralInformationThegroup of 102 male and 30 females, aged 11-70 years old,mean age 30.6 +12.5 years, of which 69 cases of

3、trafficaccident injury, falls injury in 15 cases, 17 cases of crushinjury, sharp injuries and blunt wounded31patientsparacentesis bloodof98cases underwentpreoperativeultrasonography or CT diagnosed the injury site left lobeof the 39 cases, 90 cases of the right lobe, both lobes of 12cases.Injuryseve

4、rityisgradedaccordingtotheAmericanTraumaSurgeryannualSociety(AASTliverinjury grading standards: 32 cases of grade, grade47 cases, grade 33 cases of 14 cases, , grade six1cases associated injuries, chest nine cases of traumatic brain injury .1.2 TreatmentThe group of 39 patients withnon-surgicaltreat

5、mentcured.93patientsunderwentsurgery, including simple debridement the suture 45 cases,omentum+suturerepair56cases,debridement+irregular hepatectomy in 12 cases, hepatic artery ligationtwo cases, perihepatic packing three cases. Surgery in thecorrespondingpartsoftheinjury-linesingle-tubeorperitoneal

6、 drainage tube.1.3TreatmentResultsNon-surgicaltreatmentgroup,39 cases withnodeaths,93 cases ofsurgical treatment group, which I - level liver injury nodeath. - grade 4 patients died of hemorrhagic shock, 2 patients died of multiple organ failure, and severe associated injuries after five cases of bi

7、le leakage, intra-abdominal infection in 2 cases, 2 cases of stress ulcer, drainage, anti-infection, symptomatic treatment cured.2 Discussion2.1 DiagnosisLiverinjuryis2notdifficultto diagnose,canbebasedona historyofabdominalinjuries,internalbleedingandsignsofperitonitis,supplementedbyspecialexaminat

8、ionconfirmedtheneedtopayattentiontothefollowingpoints: abdominalpuncturedecisivesignificanceinthediagnosisof liverinjuryinthisgroup of98patientswithhepaticinjuryinpatientsundergoingabdominalparacentesis,a one-time60casesofpositiveresults.patientswithsuspectedliverinjuryshouldberoutinelyabdominalpunc

9、ture,thegroupof17patientswithpositiveresults2-3timespuncture ultrasonography,CT inspected for damage as a regular and dynamic meansofmonitoring,especiallycolorDopplerultrasoundexamination,both practicalandeconomicconvenience. topreventcomplicationsconcealliverinjuryinthisgroup, the shock of the 5 pa

10、tients with early signs of live medical treatment, one week after the turn surgical rescue cure abdominal pain intensified.2.2treatment2.2.1Non-surgicaltreatment:Liver injury in non-surgical treatment in recent years, an increasing trend, the information liver injury laparotomy in350-80%ofcases have

11、theirownstop bleeding,non-surgicaltreatmentsuccess rate of up to 80%2.Along with ultrasonography, CT popularity, coupled with acomprehensivemeansofimprovingandmonitoringcapabilitiestostrengthen,increasingthesuccessrateofthe derliverinjury,shock,hemodynamic stability by, espe

12、cially in pediatric patientsmay be hospitalized for observation, to take non-surgicalmethodoftreatment,I believe that thenon-surgicaltreatmentofconditions:hemodynamicallystable(systolic blood pressure 13pka required fluid volume1000ml), (2) the estimated the celiac blood loss <500ml(3) auxili

13、ary examination confirmed , level liver injury, (4) without the need for surgical treatment ofintra-abdominalorganinjury guardianshipLinkstofree papers Download Center 2.2.2Surgicaltreatment:Althoughliverinjurypatientscan chooseanon-surgicaltreatment,butthereare still some patients need surgery leve

14、l more seriousliver injury,peritonealirritation,seriousliverinjuryinpatientswithunstablehemodynamicscontinuedemergencysurgeryrescueanimportantmeansoflife,4accordingtothe severity ofthedisease,color Dopplerultrasound,CT, andlaboratorytest resultstodeterminewhether the liver vascular injury, hepatic d

15、uct injury, withor withoutassociatedinjuriesifothersevereassociatedinjuries,needthecollaborationofmultidisciplinaryconsultation, and timely treatment.Principles of liver injury: (1) control active bleeding quickly stop the bleeding, liver damage is often associated with hemorrhagic shock, which is t

16、he leadingcause of death of liver injury, the clear inactivation livertissue, correcthandling ofliverdamageand otherintra-abdominalorganassociatedinjuries;​​toperitonealdrainagefullyeffective.surgeryfor liverinjuryaccordingto specificinjuries.Ioften used to stop bleeding in surge

17、ry: hemostasis for thepurelysuperficialliverdamagedirectlydeep woundsshould be fully revealed, debridement, tight ligation livercross-section of the vascular, biliary stump. clear necrosisof the liver tissue, suture closure rope wound, if necessary,add the omentum, stitched gelatin sea. Never leave

18、deadspace.liverThelargesurfaceareaof5​​oozing wounds spraying fibrin glue canbe used to stop bleeding, to good effect, the fibrin glueanalogclottingprocess,thethirdstep inthewoundhemostasis rapid formationof a layer of fibrousproteinfilm and promote wound healing, while close to

19、the smallbloodvesselsand bileductstoreducetherisk ofpostoperative bleeding and bile leakage.Seriousliverinjuryimplementhepatectomy,havetwo:oneis irregularliverresection,debridementresection, only large tracts of loss of blood supply, can notrepairdamagedlivertissueremoval,anotherregularityhepatectom

20、yhepaticsegment,lobestructuredividedresection of hepatectomy purpose is to stop the bleeding,so should the line is irregular liver resection or debridement resection without having to expand the the debridement line rules hepatic resection.: emergencyconditions following liver resection mortality ra

21、te is veryhigh,up to 43-59%,so to minimizethetrauma,shortenthe operation time is very important, many scholars athomeandabroad:debridementhepatectomyandregularityhepatectomycomparedmortalitydecreased,6whilenosignificantdifferencesinpostoperativecomplications. total hepatic ischemia for bleeding is d

22、ifficult to control severe hepatic venous injury; due to theinferiorvenacava,intravenousRhodobryumcausedasudden reduction and significant hypotension You shouldmassivebloodtransfusionto maintainadequatecardiacoutput,especiallyinpatientswithhypovolemia,pressurizedbloodtransfusionifnecessary.avoidhypo

23、tension, I quickly around the liver into the abdominaltamponadeoppression,fast,a lotofrehydrationblood,expand the incision, and whole abdominal exploration lineirregularhepatectomy,repairdamagedbloodvessels.postoperative complications include bleeding, severe infections, liver failure, acute renal f

24、ailure, bile leakage,intra-abdominal abscess, wound infection and so on. 4 deaths in this group of patients lead to excessive bleedingand multiple organ failure. Coagulation after close observation, regular application of hemostatic agents to control bleeding, but also to prevent thrombosis.Abdominal cavity thoroughly washed and unobstructed drainage, prevention and treatment of bile leakage and intra-abdominal infections.7Treatment of associated injuries: program the chest belly brain limbs spine has liver damage often associated injuries, which is liver damage and h