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Maryland 休克创伤中心在1983～1988年收治1787例腹部钝性伤,其中发生腹膜后血肿(RPH)233例(13%),其治疗原则为(1)第1区(中央部)RPH应手术探查以排除火血管、胰或十二指肠创伤;(2)第2区(胁部)有膨胀性或搏动性血肿,或有尿外溢者给予探查;(3)第3区(盆腔)一般不予探查,除非有明确的大血管破裂或压迫止血后病情仍恶化。同时有一个区以上的 RPH 则列为第4区。剖腹探查是诊断 RPH 的主要方法(占73%),发现1、2、3和4区 RPH 分别占14%、37%、46%和3%。使用诊断性腹腔灌洗(DPL)168例,阳性结果125例,假阳性28例。81例探查了血肿(35%),第1区最常见大血管损害(21%),第2区最常见肾损伤(27%)。第2区右侧 RPH 伴胰或十二指肠损伤(14%).122例伴腹腔内脏器损伤,计肝65例、脾64例、空腔脏器49例、肠系膜31例、横膈19例和卵巢4例.在188例存活24小时以上伤员中,共发生并发症110例(59%),计 ARDS 76例、急性肾小管坏死42例、肝功能衰竭10例、DIC 9例和胃出血2例,并发感染46例、肺栓塞8例和胰腺炎7例。死亡91例(39%),其中半数在入院后24小时内死亡。总的死亡原因为多器官衰竭37例、休克33例和头
The Maryland Shock & Trauma Center treated 1,787 abdominal blunt trauma patients from 1983 to 1988, of whom 233 (13%) had retroperitoneal hematoma (RPH). The principles of treatment were: (1) surgical exploration of RPH in zone 1 (central) (2) Swelling or pulsatile hematoma in Zone 2 (flank) or presence of excretion of urine; (3) Zone 3 (pelvic) is generally not To explore, unless there is a clear large blood vessel rupture or oppression hemostasis is still deteriorating. An RPH with more than one zone is listed as Zone 4. Laparotomy is the primary method of diagnosis of RPH (73%) and found that RPHs 1, 2, 3 and 4 accounted for 14%, 37%, 46% and 3%, respectively. 168 cases were diagnosed with peritoneal lavage (DPL), 125 cases were positive and 28 cases were false positive. Eighty-one hematomas (35%) were explored, with the most common macrovascular damage (21%) in zone 1 and the most common renal impairment in zone 2 (27%). The right side of the second RPH with pancreatic or duodenal injury (14%) .In 122 cases with abdominal visceral injury, including 65 cases of liver, spleen 64 cases, 49 cases of hollow organs, mesentery in 31 cases, diaphragm 19 Cases and ovaries in 4 cases.Of 188 cases of survived more than 24 hours in the wounded, a total of 110 cases (59%) complication occurred in ARDS 76 cases, acute tubular necrosis in 42 cases, liver failure in 10 cases, DIC in 9 cases and stomach Bleeding in 2 cases, complicated by infection in 46 cases, 8 cases of pulmonary embolism and pancreatitis in 7 cases. 91 (39%) died, of which half died within 24 hours after admission. The total cause of death was multiple organ failure in 37 cases, shock in 33 cases and head