ABSTRACT
Objective To explore the early diagnosis, option of the surgical procedures, preven-tion and treatment of the complications in patients with pancreatic trauma.Methods All patients with pancreatic trauma during the past 20 years were studied retrospectively in respect of sex, age, cause of injury, grade by AAST, style of operation, therapeutic efficacy, complications and factors for death etc.Statistical analysis was made with Chi-square test.Results In all 148 cases of the present series, 132 underwent surgical interventions including simple suture or external drainage alone, distal pancre-atectomy, distal pancreaticojejunostomy or other internal drainage, diverticularization, Whipple's pro-cedure, and Damage Control Surgery (DCS) etc.Postoperative morbidity was 27.83% with a signifi-cant difference of the incidence of pancreatic fistula between pancreas grade Ⅲ-Ⅴ injuries and grade Ⅰ-Ⅱ(P＜0.01).The mortality rate was 11.49%.The cause of the deaths was mainly massive bleed-ing due to severe associated injuries(76.47%).Among various grades, the difference of the mortality was not significant (P＞0.05).Conclusion To improve the survival rate, it is important to control massive hemorrhage from associated injuries precedes dealing with pancreas trauma.Selection of surgi-cal procedures should be based on whether the main duct is injured.The removing of devitalized tis-sue, adequate external and internal drainage are essential for treatment of pancreatic injuries.Early recognition of pancreatic injury and correct choice of surgical procedures may obviously decrease the in-cidence of postoperative complications.
ABSTRACT
Objective To probe timely diagnosis and surgical intervention of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 161 patients with TDR treated surgically in our department during the past 17 years were analyzed retrospectively in respects of diagnostic methods,accuracy of preoperative judgment of TDR,incidence of diaphragmatic hernia,surgical procedures and outcome,etc. Results There were 139 males and 22 females at a mean age of 32.4 years(9-84 years),with average ISS of 27.8 points(13-66 points).Of all patients,65.2%had shock at admission.For these 161 patients,36 suffered from blunt injuries and 125 from penetrating injuries.For diaphragmatic injury.preoperative diagnostic rate was 88.9%for blunt injuries and 78.4%for penetrating injuries (P＞0.01).The incidence of diaphragmatic hernia was 94.4%in blunt injuries and 14.4%in penetrating injuries(P＜0.05).In this series,thoracotomy was performed in 30 patients,laparotomy in 106,thoracotomy plus laparotomy in 18 and combined thoraco-laparotomy in 7,with overall fatality rate of 10.6%and a mean ISS of 41.6 points.The mortality rate was 22.2%in blunt injuries and 7.2%in penetrating injuries(P＜0.01).The main causes for death were hemorrhagic shock and septic complications; Conclusions Blunt diaphragmatic injury can be diagnosed by radiographic signs of diaphragmatic hernia.According to"offside sign",which implies a thoracic wound with positive physical or radiological signs in the abdomen or in the thorax,penetrating diaphragmatic injury can be recognized.To deal with diaphragmatic hernia,it is important to judge the vitality of viscera.Penetrating injury has a relatively good prognosis.
ABSTRACT
OBJECTIVE: To elucidate the epidemiological characteristics and to define some preventive strategies for fall injury (FI). METHODS: The medical records of patients admitted following a fall from a certain height between August 1996 and July 1997 were analyzed retrospectively. RESULTS: A total of 138 patients were assessed, with a mortality of 31.2%. The male-to-female ratio was 3.5:1. The persons between 20 and 59 years old were the main victims (81.8%), of which 52.2% were related with their work altitude. The remaining adults fall because of, accidents in daily life, suicide attempts, drug abuse, alcohol, or criminal behavior. There were significant differences between the death group and the survival group in the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) value (P<0.05 and P<0.01, respectively). Six children fall from balconies, open windows or roofs. There were significant differences for the height of fall and RTS value in aged group than those in children, adolescents, and adults (P<0.001, 0.005, 0.05; and P<0.05, 0.01, 0.05, respectively). The mortality of FI was significantly correlated to the height of fall (r=0.897, P<0.005). CONCLUSIONS: Male adults are the main victims, especially the workers at high altitudes. The mortality of FI is significantly correlated to the height of fall. The preventive strategies developed through analyzing the risk factors of fall in different age groups might reduce the injuries and deaths following fall.