新版腹部损伤英文课件-医学课件(精选).ppt.ppt
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AbdominalInjury,1,。
2,。
3,。
theoutline,theincidenceofabdominalinjuriesinpeacetime:
0.4%-1.8%inwartime:
50%themortalityofabdominalinjuriesis10%,4,。
Typesoftheabdominalinjuries,abdominalinjury,openabdominalinjury,closedabdominalinjury,penetratingabdominalinjury,non-penetratingabdominalinjury,Iatrogenicinjury,5,。
6,。
Mechanismofclosedinjury,DirectimpactDecelerationandrotationalforcesSpleen,kidney,smallbowelandliverarethemostcommonlyclosedabdominalinjuriedorgans.,7,。
Mechanismofopeninjury,StabwoundsGunshotwoundsLiver,smallbowel,stomachandcolonarecommonlyinvolvedintheopenabdominalinjuries.,8,。
Theseverityoftheinjuriesandinvolvedorgansdependontheintensity,velocity,positionanddirectionoftheforce.Abdominalanatomicfeaturesandthefunctionsoftheorgansarealsoimportanttotheinjuries.,9,。
clinicalmanifestations,abdominalpainhemorrhagicshockperitonitis,10,。
abdominalorgansinjuriesaredividedtosolidandholloworgansinjuries.themainmanifestationofthesolidorgansinjuriesishemorrhagethatcanleadtoshock.themainmanifestationoftheholloworgansinjuriesisperitonitis.,11,。
Hemorrhageandperitonitiscanexistsimultaneously,whentheinjuriesinvolvethe2kindsofabdominalorgans.,12,。
Diagnosis,Accuratediagnosisandmanagementrequiresathoroughhistory,physicalexamination,and,whenindicated,laboratorytests.,13,。
whenwediagnosetheinjuryastheopenabdominalinjury,weshouldconsiderifthereisapenetratinginjury.,14,。
Diagnosisoftheclosedabdominalinjury,Doestheabdominalorganinjuryexist?
Whichorganisinjuried?
whethermultipleorgansareinvolvedintheabdominalinjuries?
15,。
whenitsstilldifficultytodiagnose,thefollowingmeasurescanbetaken.,auxiliaryexamination,dignosticabdominalparacentesisandperitonealLavage,x-ray,Ultrasound,Abdominalcomputedtomography,MRI,angiography,diagnosticlaparoscopy,16,。
observingcloselydeterminethepulserate,respiratoryrate,bloodpressureevery15-30minutes.examinetheabdominalsignsevery30minutes.determinetheerythrocytenumber,hemoglobin,hematocritevery30-60minutes.,17,。
exploratorylaparotomy,TheindicationsforlaparotomyAbdominalpainandperitonealirritationsignaggravategradually.Boweltonesbecomesmoreweaker,evendisappeared.Theerythrocytenumberandbloodpressureareinstability.GastrointestinalbleedingRefractoryshock,18,。
Managementoftheabdominalinjury,Weshouldidentifyandcorrectanyimmediatelife-threateningconditionsandtreatwiththeotheranticipateproblems.CPRisthemostimportantthinginthecriticalcase.AAirwayBBreathingCCirculationwithhaemorrhagecontrol,19,。
Dontsendtheexposedabdominalorgansbacktotheperitonealcavity.CoverthemwithwarmNSsoakedgauze.,20,。
Antishocktherapyisakeystepinthetherapeuticprocedure.Ifgivenactiveantishocktherapy,theshockstilldifficultytocorrect,itsuggeststhatthereisprogressiveintraperitonealhemorrhage,theexploratorylaparotomyisnecessary.,21,。
Inprinciple,thelaparotomyshouldexploretheabdominalorgansinorderasthefollowing:
thesolidorgansdiaphragmastomachduodenumjejunumileummesenterypelvicorgansposteriorsurfaceofstomachpanceas,22,。
Splenicrupture,23,。
24,。
25,。
Thespleenremainsthemostcommonlyinjuredorgan.inclosedinjury:
20%40%inopeninjury:
10%,26,。
TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.TheMagnitudeofspleanicrupturedependonpatientage,injurymechanismandpresenceofunderlyingdisease.,27,。
Nowspleenisrecognizedasanimportantimmunologicfactory.Theriskofoverwhelmingpostsplenctomyinfection(OPSI)isgreatestinchildlessthan2yrs.RecognitionofOPSIhasstimulatedeffortstoConservespleenbysplenorrhaphy.,28,。
TREATMENT,InitialManagementNonoperativeapproach:
widelypracticedinpediatrictraumathecriteriafornonoperativeapproachOperativeapproach:
Decisiontoperformsplenctomyorsplenorraphyisusuallymadeafterassessment&gradingthesplenicinjury.,29,。
Contraindicationforsplenicsalvage:
ThepatienthasprotractedhypotensionUnduedelayisanticipatedinattemptingrepairthespleenThepatienthasothersevereinjury,30,。
Liverrupture,31,。
32,。
33,。
Operativemanagement-liver,Gauzepackingmayhaveinfectivecomplications(IvaturyRRetal1986)OmentalpackingResectionaldebridementMassliversutureHepaticarteryligationTotalhepaticisolation-goodforretrohepaticvenousinjuriesAtriocavalshunt,34,。
35,。
36,。
pancreaticinjury,37,。
CharacteracuteabdominalpainbecauseofthechemicalperitonitiscausedbypancreaticjuiceAMYinthebloodandurinedifficulttodiagnosebeforethelapartomy,38,。
Treatmentkposthesispartialexcisionanddrainage,39,。
Gastricinjury,40,。
CharacterPeritonitispneumoperitoneumTreatmentkposthesisexcision,41,。
Duodenalinjury,42,。
CharacternotinjuriedeasilynotnoticedeasilymostlysevereTreatmentkposthesisanastomosisdecompressionanddrainage,43,。
Smallintestinerupture,44,。
CharacterhighincidenceratePeritonitisisthemainmanifest.pneumoperitoneumTreatmentKposthesisPartialexcisionandanastomosisThebloodvesselsofintestinalmesentericradixshouldbeanastomosed.,45,。
Colonrupture,46,。
CharacterthethinintestinalwallandthepoorvascularsupplypoorhealingfunctionseriousinfectioneasytomissingdiagnoseTreatmentexteriorizetheintestinalcanalColostomyandKposthesissometimesprimarysuture,47,。
Rectalinjury,48,。
Charactersaresimilartothecolonrupture.TreatmentsigmoidostomyKposthesisandanastomoses,49,。
Retroperitonealhematoma,50,。
CharacterworseconditionmorecomplicatedinjuriesdifficultytodiagnoseTreatmentexpectanttreatmenttheexploratorylaparotomy,51,。
THANKYOU!
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