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非手术治疗闭合性脾破裂38例体会
在腹部外伤中,脾破裂居于首位,占20%~40%.剖腹探查切除脾脏为传统的处理原则.江苏省泗洪县人民医院从2004年4月至2008年12月共收治外伤性脾破裂108例,其中38例采取非手术治疗,36例获得成功,约占94.9%,取得了较为满意的治疗效果.现报告如下.
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重视外伤性脾保留手术
1549年,Zacaccli完成世界上第一例脾切除手术.直至20世纪中叶,全脾切除术一直是治疗脾外伤的金标准.脾脏"切之无害"论整整延续了400年.脾脏,难道真是"可有可无的脏器"吗?
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Objective To study whether liver cirrhosis associated with Helicopacter pylori (H. pylori)infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia.Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H.pylori infection and non-cirrhotic patients (splenic rupiure) with and without H. pylori infection, and the serum ammonia was measured.Results The mean levels of serum ammonia in the group of cirrhotic patients with H. pylori infection were 167.82±8.97 μmol/L (pertal vein) and 142.2±13.35 μmol/L (cubital vein). They were increased significantly as compared with cirrhotic patients without H.pyiori infection(47.68±12.03 μmol/L portal vein and 37.23±7.04 μmol/L cubital vein),and also compared with the groups of splenic rupture patients with and without H. pylori infection (P<0.0t).There was no significant difference between the serum ammonia level of the cubital vein and pertal vein(P>0.05).Conclusions H.pylori intection can induce an increase in serum ammonia in patients with liver dysfunction,and the peripheral serum ammonia measurement may replace the portal vein serum ammania as a monitoring method. Eradication of H.pylori in cirrhotic patients may prevent hepatic encephalopathy(HE).
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1例慢性胰腺炎急性坏死合并自发性脾破裂病人的护理
对1例慢性胰腺炎急性坏死合并自发性脾破裂病人的抢救、观察与护理进行了总结,为胰腺炎病人并发症的观察、护理提供参考.
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1例脾破裂并发渗出性胸膜炎病人的护理
脾破裂出血术后并发肺炎在临床上较常见,而并发渗出性胸膜炎较为罕见.我科收治1例由于脾破裂出血而致渗出性胸膜炎的病人.现将护理报告如下.
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延迟性脾破裂的诊断与外科治疗
延迟性脾破裂(delayed splenic rupture,DSR)是外伤性脾破裂的一种特殊类型,约占脾外伤的10%~15%[1].因其伤情隐匿、病情急、变化快,易误诊,其死亡率和误诊率高于一般的脾破裂[2].早期诊断和及时手术治疗是治愈本病的关键.我院自2001年3月至2005年3月间共收治延迟性脾破裂20例,现就外科诊治中的体会总结如下.
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超声诊断新生儿脾破裂1例
患儿女,3 d又9 h,因“出生后拒乳、少哭、少动伴嗜睡,加重1 d”入院。足月顺产,出生体质量4050 g,Apgar评分不详。体格检查:体温36.5℃,脉搏185次/min,呼吸60次/min,血压75/43 mm Hg (1 mm Hg=0.133 kPa),嗜睡,全身皮肤苍黄,前囟平,双侧瞳孔等大等圆,对光反射稍迟钝,口唇无发绀,呼吸促,双肺呼吸音粗,两肺底闻及少量湿啰音,心音有力未及杂音,腹部膨隆伴肌紧张。实验室检查:白细胞16.3×109/L,血红蛋白57 g/L,红细胞压积19.7%,中性粒细胞比率71.1%,淋巴细胞比率21.0%。超声检查:肝、胆、胰、肾未见异常;脾脏增大,形态饱满,大小62 mm×52 mm×52 mm,上端脾包膜不连续(图1),实质破裂处呈条带状回声,其间可见狭长无回声区;脾肾之间及肠曲间见大片不规则无回声区混杂细小点状回声,深处约71 mm(图2)。超声提示:①脾破裂;②腹腔大量积血。 CT检查:脾脏正常结构消失,大小约66 mm×58 mm×56 mm,呈巨大团块状混杂密度影,腹腔内示大量水样密度影。CT提示:①脾破裂;②大量腹水。术中所见:腹腔内充满血凝块及不凝血,约300 ml,脾脏呈碎裂状,脾门处见活动性出血,破口较大。术后诊断:脾破裂,腹腔积血。病理诊断:充血性脾肿大伴破裂出血。