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1、腹部损伤英文课件腹部损伤英文课件本讲稿第一页，共五十一页本讲稿第二页，共五十一页本讲稿第三页，共五十一页the outlinethe incidence of abdominal injuries in peacetime:0.4%-1.8%in wartime :50%the mortality of abdominal injuries is 10%本讲稿第四页，共五十一页Types of the abdominal injuriesabdominal injuryopen abdominal injuryclosed abdominal injurypenetrating abdomin
2、al injurynon-penetrating abdominal injuryIatrogenic injury本讲稿第五页，共五十一页本讲稿第六页，共五十一页Mechanism of closed injuryDirect impactDeceleration and rotational forcesSpleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs.本讲稿第七页，共五十一页Mechanism of open injuryStab woundsGunshot
3、 woundsLiver,small bowel,stomach and colon are commonly involved in the open abdominal injuries.本讲稿第八页，共五十一页The severity of the injuries and involved organs depend on the intensity,velocity,position and direction of the force.Abdominal anatomic features and the functions of the organs are also impor
4、tant to the injuries.本讲稿第九页，共五十一页clinical manifestationsabdominal painhemorrhagic shockperitonitis本讲稿第十页，共五十一页abdominal organs injuries are divided to solid and hollow organs injuries.the main manifestation of the solid organs injuries is hemorrhage that can lead to shock.the main manifestation of t
5、he hollow organs injuries is peritonitis.本讲稿第十一页，共五十一页Hemorrhage and peritonitis can exist simultaneously,when the injuries involve the 2 kinds of abdominal organs.本讲稿第十二页，共五十一页DiagnosisAccurate diagnosis and management requires a thorough history,physical examination,and,when indicated,laboratory t
6、ests.本讲稿第十三页，共五十一页when we diagnose the injury as the open abdominal injury,we should consider if there is a penetrating injury.本讲稿第十四页，共五十一页Diagnosis of the closed abdominal injuryDoes the abdominal organ injury exist?Which organ is injuried?whether multiple organs are involved in the abdominal inju
7、ries?本讲稿第十五页，共五十一页when its still difficulty to diagnose,the following measures can be taken.auxiliary examinationdignostic abdominal paracentesis and peritoneal Lavagex-ray UltrasoundAbdominal computed tomographyMRI,angiography,diagnostic laparoscopy 本讲稿第十六页，共五十一页 observing closely determine the pul
8、se rate,respiratory rate,blood pressure every 15-30 minutes.examine the abdominal signs every 30 minutes.determine the erythrocyte number,hemoglobin,hematocrit every 30-60 minutes.本讲稿第十七页，共五十一页 exploratory laparotomy The indications for laparotomyAbdominal pain and peritoneal irritation sign aggrava
9、te gradually.Bowel tones becomes more weaker,even disappeared.The erythrocyte number and blood pressure are instability.Gastrointestinal bleedingRefractory shock本讲稿第十八页，共五十一页Management of the abdominal injuryWe should identify and correct any immediate life-threatening conditions and treat with the
10、other anticipate problems.CPR is the most important thing in the critical case.AAirway BBreathing CCirculation with haemorrhage control本讲稿第十九页，共五十一页Dont send the exposed abdominal organs back to the peritoneal cavity.Cover them with warm NS soaked gauze.本讲稿第二十页，共五十一页Antishock therapy is a key step i
11、n the therapeutic procedure.If given active antishock therapy,the shock still difficulty to correct,it suggests that there is progressive intraperitoneal hemorrhage,the exploratory laparotomy is necessary.本讲稿第二十一页，共五十一页In principle,the laparotomy should explore the abdominal organs in order as the f
12、ollowing:the solid organs diaphragma stomach duodenum jejunumileummesentery pelvic organs posterior surface of stomach panceas本讲稿第二十二页，共五十一页Splenic rupture本讲稿第二十三页，共五十一页本讲稿第二十四页，共五十一页本讲稿第二十五页，共五十一页The spleen remains the most commonly injured organ.in closed injury:20%40%in open injury:10%本讲稿第二十六页，共五
13、十一页The Magnitude of spleanic rupture depend on patient age,injury mechanism and presence of underlying disease.The Magnitude of spleanic rupture depend on patient age,injury mechanism and presence of underlying disease.本讲稿第二十七页，共五十一页 Now spleen is recognized as an important immunologic factory.The r
14、isk of overwhelming postsplenctomy infection(OPSI)is greatest in child less than 2 yrs.Recognition of OPSI has stimulated efforts to Conserve spleen by splenorrhaphy.本讲稿第二十八页，共五十一页TREATMENTInitial ManagementNon operative approach:widely practiced in pediatric trauma the criteria for nonoperative app
15、roachOperative approach:Decision to perform splenctomy or splenorraphy is usually made after assessment&grading the splenic injury.本讲稿第二十九页，共五十一页Contraindication for splenic salvage:The patient has protracted hypotension Undue delay is anticipated in attempting repair the spleen The patient has othe
16、r severe injury本讲稿第三十页，共五十一页Liver rupture 本讲稿第三十一页，共五十一页本讲稿第三十二页，共五十一页本讲稿第三十三页，共五十一页Operative management-liverGauze packingmay have infective complications(Ivatury RR et al 1986)Omental packingResectional debridementMass liver sutureHepatic artery ligationTotal hepatic isolation-good for retrohepati
17、c venous injuriesAtriocaval shunt本讲稿第三十四页，共五十一页本讲稿第三十五页，共五十一页本讲稿第三十六页，共五十一页pancreatic injury 本讲稿第三十七页，共五十一页Characteracute abdominal pain because of the chemical peritonitis caused by pancreatic juiceAMY in the blood and urine difficult to diagnose before the lapartomy本讲稿第三十八页，共五十一页Treatmentkposthesi
18、spartial excision and drainage本讲稿第三十九页，共五十一页Gastric injury本讲稿第四十页，共五十一页CharacterPeritonitispneumoperitoneum Treatmentkposthesisexcision本讲稿第四十一页，共五十一页Duodenal injury本讲稿第四十二页，共五十一页Character not injuried easily not noticed easilymostly severe Treatmentkposthesisanastomosisdecompression and drainage本讲稿第
19、四十三页，共五十一页Small intestine rupture本讲稿第四十四页，共五十一页Character high incidence rate Peritonitis is the main manifest.pneumoperitoneumTreatmentKposthesisPartial excision and anastomosisThe blood vessels of intestinal mesenteric radix should be anastomosed.本讲稿第四十五页，共五十一页Colon rupture本讲稿第四十六页，共五十一页Character t
20、he thin intestinal wall and the poor vascular supply poor healing function serious infection easy to missing diagnose Treatmentexteriorize the intestinal canalColostomy and Kposthesissometimes primary suture本讲稿第四十七页，共五十一页Rectal injury本讲稿第四十八页，共五十一页Characters are similar to the colon rupture.TreatmentsigmoidostomyKposthesis and anastomoses本讲稿第四十九页，共五十一页Retroperitoneal hematoma本讲稿第五十页，共五十一页Character worse condition more complicated injuries difficulty to diagnoseTreatmentexpectant treatmentthe exploratory laparotomy本讲稿第五十一页，共五十一页