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目的 探讨儿童腹部闭合伤的保守治疗及手术探查的指征和时机。 方法 将我院１９９０ 年１ 月至１９９８ 年１０ 年住院的２１６ 例腹部闭合伤患儿分为肝脏损伤、脾脏损伤、肾脏损伤、胃肠道损伤、胰腺损伤、输尿管损伤、膀胱损伤，并逐一对其进行回顾性分析。 结果 ６５ 例肝损伤，６ 例行剖腹探查；５４ 例脾损伤，８ 例手术，１ 例行脾切除，脾保留９８ ％ （ 未包括２ 例巨脾外伤行脾切除的患儿） ；１８ 例胃肠道损伤，１３ 例手术探查（ 其中５ 例住院后立即手术，８ 例住院２４ 小时后手术） ；６ 例输尿管损伤，均在伤后６ ～２０ 天手术；４ 例膀胱损伤均急诊手术修补；１２ 例胰腺损伤，２ 例手术治疗，１０ 例保守治疗，保守治疗患儿中４ 例伤后４ 周出现假性胰腺囊肿。 结论 （１） 肝损伤保守治疗有一定危险性，输液后，输血超过４０ ｍｌ／ｋｇ ，患儿血压仍不能稳定在正常范围内或出现胆汁性腹膜炎的患儿应手术探查。转氨酶的变化对判断肝损伤严重程度非常有用。（２） 脾损伤患儿输液后输血超过４０ ｍｌ／ｋｇ血压仍不能维持在正常范围内，或巨脾出现脾损伤患儿应手术探查，并应切除巨脾。（３） 胃肠道损伤合并气腹或腹膜炎表现持续加重尤其早期患儿体温明显增高时应手术探查。（
Objective To explore the indications and timing of conservative treatment and surgical exploration of abdominal closed wounds in children. Methods 216 cases of abdominal closed-wound hospitalized in our hospital from January 1990 to October 1998 were divided into liver injury, spleen injury, kidney injury, gastrointestinal injury, pancreatic injury, ureteral injury, bladder injury, and one by one It was retrospectively analyzed. Results Sixty-five cases of liver injury and 6 cases of laparotomy were explored. Fifty-four cases of spleen injury and eight cases of operation were treated with splenectomy in one case and spleen in 98% cases (excluding 2 splenectomy cases with splenomegaly) Intestinal injury, surgical exploration in 13 cases (5 cases were operated immediately after hospitalization, 8 cases were hospitalized 24 hours after surgery); 6 cases of ureteral injury, were surgery 6 to 20 days after injury; 4 cases of bladder injury were emergency surgical repair; 12 cases of pancreatic injury, 2 cases of surgical treatment, 10 cases of conservative treatment, 4 cases of children with conservative treatment 4 weeks after injury, there were false pancreatic cysts. CONCLUSIONS: (1) Conservative treatment of liver injury has a certain risk. After transfusion, blood transfusion more than 40 ml / kg, blood pressure in children still can not be stabilized within the normal range or biliary peritonitis in children should be surgical exploration. Aminotransferase changes to determine the severity of liver damage is very useful. (2) Infants with splenic injury who transfused more than 40 ml / kg of blood could not maintain the normal range or splenomegaly had splenic injury in children, and giant spleen should be removed. (3) Gastrointestinal trauma combined with pneumoperitoneum or peritonitis continued to worsen, especially in early infantile temperature was significantly higher surgical exploration should be. (