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Objective To analyze the risk factors that influence prognosis of pancreatic injury.Methods The clinical data of 73 patients with pancreatic injury were analyzed retrospectively.Univariate analysis and multivariate Logistic regression were performed to analyze the clinical parameters.Results Complications occurred in 27 patients with the overall incidence rate of 36.9％.6 patients died with the mortality of 8.2％.Result of univariate analysis indicated that the volume of blood loss,systolic blood pressure,injury grade by American Association surgery of Trauma (AAST),pancreatic leakage,time on admission were significant factors that influence the incidence rate of complications (P ＜ 0.05).The results of Multivariate Logistic regression indicated that the volume of blood loss,systolic blood pressure,injury grade by AAST,time on admission were independent predictors for prognosis in pancreatic injury (OR =3.764,0.940,7.315,1.501,all P ＜ 0.05).Conclusion It should pay attention to all the factors that influence the prognosis of pancreatic injury in clinic.Exact judgment and appropriate treatment plan are helpful to increase achievement ratio of pancreatic injury.
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Objective To explore the risk factors of adhesive small bowel obstruction for the influence of the long-term therapeutic effects.Methods 218 case of adhesive small bowel obstruction in patients were treeted with a long follow-up and retrospective analysis.Results Among the 218 admissions in 235 patients,192 admissions (81.7.％) were surgical treated and 43 admissions(18.3％) were performed conservative treatment.The mean recovery time was 65.7 months and the accumulative incidence of surgical recurrence in 5 years was 19.0％ in surgical group and those in conservative group were 50.4 months and 34.0％ respectively.There was significant difference between two groups (P ＜ 0.05).Conclusion The long-term efficacy of risk factors was related to the treatment before the operation site and times,the last operation to the incidence of admissions.No other independent risk factor of recurrence was found.Surgical treatment serves as a better way in the prevention of later recurrences in patients with adhesive intestinal obstruction under certain conditions.
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Objective To evaluate the value of contrast-enhanced ultrasound(CEUS) in diagnosis of placental increta.Methods Twenty seven suspected patients with placental increta were examined with CEUS after routine ultrasound examination.SonoVue was injected intravenously as bolus and a real time CEUS was performed.The characteristics of contrast perfusion was analysised.Results Among the three antepartum CEUS cases,two had a clear boundary between the placenta and uterine wall,there was no residual placenta after induced labor;one had a blur boundary between the local placenta and uterine wail,and the local placenta adherenced to the uterine wall tightly when cesarean section was performed after induction failure.Comparison between CEUS and uterine curettage in 20 cases,5 cases had a dear boundary between residual disease in uterine cavity and uterine wall.The boundary between residual disease in uterine cavity and uterine wall disappeared in other 15 cases.Four cases performed total and subtotal hysterectomy,the uterine myometrium of placenta affixing part were very thin (3 - 5 mm),and the boundary between the placenta and uterine wall disappeared,and placental increta was proved by intraoperative and pathology.Conclusions When the boundary between residual placenta and uterine wall disappeared and/or the local uterine wall became thin,placental increta was suggested intensively.
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Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS) in the diagnosis of postnatal placenta increta. Methods Twenty-six patients with postnatal placenta increta were examined by gray-scale and color Doppler ultrasound and CEUS. Then microvascular perfusion and enhanced features of lesions, myometrium and serous layer were observed. Arriving time (AT), time to peak intensity (TTP) and the lasting time of enhancement (LTE) were recorded. AT,TTP and LTE of enhanced lesions were compared with those of normal myometrium. Results Serous layer, lesions and adjcent myometrium,normal myometrium enhanced in turn. There was no obvious boundary between the lesions enhanced and adjcent myometrium. AT and TTP of the lesions enhanced were both less than those of normal myometrium ( P ＜0. 05). LTE of the part of lesions enhanced was more than that of normal myometrium ( P ＜0.05).Part of lesions never enhanced during the whole process. The serous layer of uterine was smooth and uninterrupted in 24 patients. These 24 patients all recovered after conservative treatment. The local serous layer adjcent lesions was not smooth, but no contrast agent leakage occurred in another 2 patients, and uterine lobectomy were performed in emergency because of massive hemorrhage during conservative treatment. Conclusions Microvascular perfusion and enhanced features of lesions,myometrium and serous layer could be showed clearly through CEUS.