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目的探讨急性重度胸腹联合损伤(combined thoracoabdominal injury,CTI)的特点和急救经验。方法总结1999年2月至2009年12月经手术证实的急性重度CTI56例,其中开放性损伤42例,闭合性损伤14例。56例均有不同程度血胸或血气胸伴有休克。分析不同原因的损伤及不同症状与抢救方式。结果经胸手术39例,剖腹手术15例,胸腹联合手术2例。首次手术探查发现膈肌破裂52例,4例漏诊,均行二次手术修复。治愈42例,死亡14例。结论重度CTI病死率高,伤情复杂,一般原则应先处理胸部损伤,后处理腹部损伤,但应防止漏诊膈肌损伤。在抗休克的同时及早诊断、及时手术是抢救成功的关键。
Objective To investigate the characteristics and emergency treatment experience of combined acute thoracoabdominal injury (CTI). Methods From February 1999 to December 2009, 56 cases of acute severe CTI confirmed by surgery were performed, including 42 open injuries and 14 closed injuries. 56 cases have varying degrees of hemothorax or hemothorax associated with shock. Analysis of different causes of injury and different symptoms and rescue methods. The results of thoracic surgery in 39 cases, laparotomy in 15 cases, thoracoabdominal surgery in 2 cases. The first surgical exploration found that 52 cases of diaphragmatic rupture, 4 cases of missed diagnosis, were performed second surgery. 42 cases were cured, 14 died. Conclusion Severe CTI has a high mortality rate and complicated injury. The general principle should be to deal with chest injury and post-treatment of abdominal injury. However, the diagnosis of diaphragmatic injury should be prevented. In the anti-shock at the same time early diagnosis and timely surgery is the key to the success of the rescue.