Objective To study the early diagnosis,surgical treatment options,prevention and management of complications in patients with duodenal trauma.Methods All patients with duodenal trauma treated operatively from January 2009 to December 2018 were studied retrospectively.Factors including sex,age,cause of injury,AAST grading,diagnostic method,operative procedure,therapeutic effectiveness,complications,and factors related to death were analyzed.The "double-tube gastrostomy" technique consisting of duodenal decompression and jejunal feeding as recommend by the authors were used in severe cases.Results Blunt trauma occurred in 66 of 86 patients (76.7％).The diagnosis of duodenal trauma was made preoperatively based on abdominal signs,peritoneocentesis,and imaging in 32 patients (37.2％).The remaining 54 patients (62.8％),with duodenal injury was detected during emergency laparotomy.All the 86 patients underwent surgical intervention which included simple suturing,pedicled jejunal flap,segmental resection and anastomosis,Roux-en-Y duodenojejunostomy,diverticularization,and Whipple's procedure using the principle of Damage Control Surgery (DCS).Postoperative morbidity occurred in 15 patients (17.4％).There was a high incidence of duodenal (or pancreatic,biliary) fistulae.The overall mortality rate was 12.8％ (in 11 patients).The causes of deaths were mainly massive bleeding and poly-trauma.Conclusions To decrease morbidity and mortality rates,early diagnosis and surgical intervention were critical.The choice of surgical treatment procedures should be based on the duodenal trauma grading and whether there were associated injuries.For patients with a combined pancreaticoduodenal trauma,DCS is a wise procedure to adopt.The double-tube gastrostomy technique as recommended by the authors is beneficial to severe cases in decreasing the incidences of postoperative duodenal and jejunal obstruction.

Objective To summarize treatment methods for severe liver trauma associated with trauma-in-duced coagulopathy .Methods The clinical data of 32 sustained severe liver trauma patients associated with trau-ma-induced coagulopathy were collected from Feb .2010 to Apr.2016 in Chongqing Emergency Medical Center . There were 23 males and 9 females with an average age of 37.4(15-84) years.Seventeen cases (56.3%) were in-jured from road traffic accidents ,10 were from high falling/falling,3 were from crushing and 2 were from other causes . The methods of damage control resuscitation and treatment results were analyzed retrospectively .Results All the 32 cases had multiple injuries .The rapid assessment of the severity of injury was done in admission according to the principle of"CRASH PLAN",while the establishment of venous access and coagulation function ,cross matching and other tests were performed ,and the cases were resuscitated according to the principle of damage control resuscitation (DCR).Preoperative coagulation dysfunction occurred in 19 cases.Massive blood transfusion was achieved in 22 cases by fresh frozen plasma(FFP),packed red blood cells(PRBC) in the ratio of 6-10u, respectively and 10u of cryoprecitation.Liver trauma was grade Ⅳ in 20 cases,and was grade Ⅴin 12 cases.Damage control surgery in-cluding debridement hepatectomy was performed in 22 cases and improved peri-hepatic packing was performed in 13 cases.The operative time was 30min-1.5h.In this group,24 cases were survived ,and the overall mortality rate was 25%(8/32).Six (18.8%,6/32)cases died of liver injury with or without complications .Besides associated inju-ries inside and outside the abdomen , exsanguination due to liver trauma and coagulopathy was the main cause of death.Conclusion Trauma-induced coagulopathy would easily develop in patients with liver trauma of grade Ⅳand gradeⅤ.DCR is the main protocol in treating such patients .Improved perihepatic packing and debridement hepatectomy are the main damage control measures in treating severe liver trauma associated with trauma -induced coagulopathy .

Objective To evaluate the therapeutic methods and effect of pre-hospital and in-hospital inte-grated treatment for severe crush injuries of extremities . Methods The clinical data of 49 patients with severe crush injuries of extremities from May 2008 to Jul.2015 in Chongqing Emergency Medical Center was retrospectively studied.There were 44 males and 5 females,with age ranging from 19 to 82 years (average,43.7 years).There were 5 cases of earthquake injury ,20 cases of traffic accident injury ,17 cases of mining accident injury ,and 7 cases injured by other causes .Injured sites of crushes were as follows: shoulder and upper limbs in 8 cases ( 16.3%) , pelvic and lower limbs in 41 cases(83.7%).Thirty-two cases(65.3%) were associated with fractures and disloca-tion of pelvis and joints,and 44 cases were associated with multiple injuries (89.8%).Results Pre-hospital time was 35min-49h.Venous pathway was established and infusion was applied in 19 cases during on-the-scene rescue and tourniquet was applied in 31 cases (63.3%).Decompressive fasciotomy was performed in 1 case and amputa-tion was performed in 1 case during on-the-scene rescue .Electrocardiogram monitoring was performed in all cases after decompression.In-hospital therapeutic measures included vacuum sealing drainage (VSD) in 14 cases after debridement and 17 cases with decompressive fasciotomy . The effective rate of VSD was 96.8%( 30/31 ) and no case was amputated in this group .The incidence rate of crush syndrome (CS) was 57.1%(28/49),of which 11 cases (22.4%) were combined with hyperkalemia ,and 8 cases with renal failure.Eight cases were treated with ventilator assisted therapy and 8 cases were treated with continuous renal replacement therapy ( CRRT ) . At the end,31 cases(63.3%) were cured,13 cases(26.5%) were improved,and 5 cases(10.2%) were uncured,which included 3 cases ( 6.1%) of amputation and 1 death case ( 2.0%) died from failed cardiopulmonary resuscitation due to hyperkalemia .Conclusion Tourniquet and electrocardiogram monitoring should be emphasized in pre-hos-pital treatment of severe crush injuries of extremities .Application of VSD in in-hospital treatment can reduce the in-cidence rate of amputation of severe crush injuries of extremities .

Objective To analyze the clinical effect of vacuum sealing drainage (VSD) on skin and soft tissue injury in elderly patients.Methods A total of 75 patients with severe skin and soft tissue injury who met the inclusion criteria were enrolled in this study.They were divided into two groups based on admission dates:the observation group (n =40,receiving VSD treatment,oddnumber date admission) and the control group (n=35,receiving routine dressing changes,even number date admission).The clinical indexes including pain score,wound healing time,infection rate and complications were analyzed and compared between the two groups.Results There was a significant difference in the average length of hospitalization between the two groups (21.3 days vl 30.7 days,t=7.60,P=0.0000).The infection rate was lower in the observation group than in the control group (12.5％ or 5/40 vs.54.3％ or 19/35,x2=13.12,P=0.0003).The incidence of complications was lower in the observation group than in the control group (15.0％ or 6/40 vs.42.9％ or 15/35,x2=5.87,P=0.0154).There were no deaths in the observation group,but one patient died from acute pulmonary embolism in the control group during hospitalization.Conclusions VSD can alleviate pain,reduce the infection rate,shorten the length of hospitalization and decrease bedridden complications in elderly patients with severe skin and soft tissue injury,and has valuable applications in clinical practice.

Objective To explore the measures for prevention and treatment of intra-abdominal infection in liver trauma.Methods The clinical data of 314 patients with liver trauma between Jan.2006 and Dec.2015 was analyzed.There were 221 males and 93 females,with age ranging from 15 to 76 years( average,38 years) .Totally 129 cases received non-operative treatment,and 185 cases received operative treatment.Results Fifty-four cases occurred peritoneal infection,all of whom were from the operation group,with the infection rate of 29.2%.Of the 185 cases in the operation group,there were 73 cases of isolated hepatic injury( according to American Association for the Surgery of Trauma, 68 cases of gradeⅢto gradeⅤwith 14 cases developing peritoneal infection,and 5 ca-ses of gradeⅠ-Ⅱwithout peritoneal infection).A total of 112 cases were associated with other organ injuries (33 out of 67 cases of gradeⅢto gradeⅤdeveloped peritoneal infection,and 7 cases of 45 cases of gradeⅠ-Ⅱdeveloped peritoneal infection.Of 54 patients with peritoneal infections,49 cases were cured(90.7%).Conclusion The inci-dence of intra-abdominal infection is high in the patients with severe hepatic injury or associated with multi-organ inju-ry in the abdomen.Reasonable surgical procedures based on classification of liver trauma,adequate drainage and com-bined application of preventive techniques can effectively decrease the incidence and mortality of intra-abdominal in-fections in liver trauma.

Objective To summarize the experiences of prehospital first aid in patients with severe thoracic trauma and to improve the skills of prehospital first aid. Methods A total of 1162 patients with severe thoracic trauma (AIS≥3) in Chongqing Emergency Medical Center from Jan.2009 to Dec.2014 were retrospectively ana-lyzed in respect of the injury severity of chest,methods of prehospital first aid,hospital treatment and outcome,etc. Among those patients 827 were male and 335 were female. The average age was ( 45.3 ±10.8 ) years ( 13-98 years) .Results Airway foreign bodies were removed in 31 patients.Intubation and ventilation were performed in 41 patients.Emergency tracheotomy was carried out in 23 patients and 25 patients with tension pneumothorax were decompressed by a needle or tube thoracostomy. Forty three patients with paradoxical respiratory movement were corrected by rib sunpension traction or positive-pressure ventilation.151 patients with open chest wounds were closed by medical dressing.Sixteen patients with cardiac arrest underwent unarmed cardiopulmonary resuscitation. No special measures were taken in 735 patients.Twenty-nine patients died.Conclusion Quick and accurate as-sessment,skilled and proper rescue are keys for severe thoracic trauma patients in demand of first aid and earn chance and time for further treatment in hospital.

Objective To investigate clinical effect of damage control surgery (DCS) in treatment of patients with flail chest combined with severe multiple injuries.Methods A total of 187 cases of flail chest combined with severe multiple injuries treated by fixation of floating chest wall were enrolled and divided into three groups on the basis of different treatments:DCS group (66 cases) underwent early suspension traction of ribs and delayed internal fixation of the ribs ; Group A (70 cases) underwent rib suspension traction alone; Group B (51 cases) underwent initial internal fixation of rib.Complications,mortality,and main parameters before and after operation in each group were analyzed and compared.Results Complications including pulmonary infection (32 cases),atelectasis (38 cases),and acute lung injury (ALI)/ARDS (39 cases) were found.Twenty-two cases died,including 13 deaths from ARDS,two from tension pneumothorax,one from massive hemoptysis,three from cardiac shock,two from craniocerebral injury,and one from liver trauma and thus the overall death rate occupied 11.8％.Oxygenation index (OI) had significant rise postoperatively both in the DCS group and Group A (P ＜ 0.01),but the change of OI was inappreciable in Group B.Mortality,complication rate,cases treated with mechanical ventilation,tracheotomy or fiberoptic bronchoscopy,and average length of ICU and hospital stay were the lowest in the DCS Group,followed by a relatively higher result in Group B and a much higher result in Group A (P ＜ 0.01).Conclusion DCS decreases mortality and complications dramatically when appolied to treat flail chest combined with severe multiple trauma.

Objective To investigate the trauma mechanism,injury characteristics,early diagnosis and treatment of the drivers with steering wheel injuries.Methods The clinical data of 122 patients who suffered from steering wheel injuries in our hospital from Jan.2007 to Dec.2011 were analyzed retrospectively.Results Among these 122 patients,there were 27 patients with cranial or cervical trauma,64 patients with chest trauma,56 patients with abdomen trauma,41 patients with extremities,pelvic or spine fracture.There were 81 patients with poly-trauma.Totally 115 patients were survived.The survival rate was 94.3%(115/122) and the mortality was 5.7%(7/122).The main cause of death was the injuries with cranial trauma.Conclution Steering wheel injuries in drivers usually were severe and accompanied with high poly-trauma rate.Mostly severe thoracoabdominal trauma need surgical treatment.Blunt cardiac injuries and pancreaticoduodenal injuries are easy to be miss-diagnosed and mis-diagnosed,so doctors should pay more attention to these conditions.

回顾性总结106例以方向盘损伤为主的交通伤患者的诊断和治疗。认为在撞车事故中,驾驶员遭受方向盘挤压时,钝性心脏伤和胰十二指肠伤有极高的发生率。对这一受伤人群应特别警惕这两种隐匿而危险的胸腹部损伤。

总结骨盆及盆底创伤大出血髂内动脉结扎或造影栓塞65例的体会。考虑合并有腹腔脏器伤采用髂内动脉结扎术,反之采用栓塞术是对骨盆及盆底创伤大出血有效的治疗手段。不提倡先栓塞后剖腹术。

Objective To analyze the problems existing in diagnosis of traumatic hip joint fracture and choose more appropriate internal fixation procedure.Methods A retrospective analysis of diagnosis by 3D-CT and X-ray of 26 patients with traumatic hip joint fracture was performed.Results Among 11 patients with complex hip joint fracture detecting by 3D-CT,4 patients omitted by X-ray.The other 5 patients combined with humeral head fracture and dislocation were detected by 3D-CT,but the two bone fractures were omitted in X-ray image.Conclusion Comparing with routine X-ray image and CT scan,3D-CT technique shows incomparable superiority in the diagnosis and therapy of the hip joint injury.

<正>胸、腹伤为主的多发伤常有大出血和通气障碍,且休克发生率和病死率高,又易被其他部位伤掩盖,这给早期诊治带来一定困难。笔者结合1990年1月至2005年12月重庆市急救医疗中心收治的2002例胸或(和)腹伤为主的多发伤患者作回顾性分析,现报道如下。

Objective To evaluate operative and perioperative treatment for colorectal injuries.Methods The clinical data of 125 patients with colorectal injuries treated over a period of 19 years were retrospectively studied.Results In 69 patients with perforated colon or intraperitoneal segment of the rectum, 56(81.16 %) were managed with primary repair or anastomosis, 11 cases received a colostomy, and 2 cases had Damage control surgery. In the 18 patients with perforated extraperitoneal segment of the rectum, 14 underwent diverting colostomy of the proximal end of sigmoid with presacral drainage; 4 cases, whose wound was small and contamination was mild, received primary repair without colostomy; and the other 38 cases without full-thickness lesions of the colon and rectum were treated by simple suture. The overall mortality rate was 6.40 %(8/125); 7 patients died of hemorrhagic shock during the operation(n=6) or after the operation(n=1), and the another one died from septic complication of the thoracic cavity. The complications related with operation for colorectal trauma included local infection in 6 and intestinal obstruction in one; all of them were cured. Conclusions In most of the patients with injury of colon or intraperitoneal segment of rectum, primary repair or anastomosis can be carried out safely. Rational use of perioperative antibiotics, especially Metronidazole, is a necessity. Staged operation is used for injuries of extraperitoneal segment of rectum; a completely diverting proximal sigmoid colostomy should be performed, because a loop style colostomy can not interrupt contamination of the distal rectum.

胸腹遭受钝性暴力或下胸上腹穿透伤,均可导致胸腹联合伤.患者常有多发伤使伤情互相掩盖,如缺乏警惕性和对伤情特点的认识,易造成早期诊治延误.我科1990年1月至2005年12月收治胸腹联合伤155例,现总结救治体会如下.

OBJECTIVE:To probe the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.METHODS:The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.RESULTS:Ligation of internal iliac arteries was performed in 33 cases for ceasing massive bleeding due to pelvic fracture, and angioembolization in 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 9% (7/79); The main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4, thrombosis of right common iliac artery in 1, acute respiratory distress syndrome (ARDS) following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.CONCLUSIONS:Prompt diagnosis and proper treatment were the key of the success. Devascularization of internal iliac arteries with external fixation cage of pelvis, cystostomy and proximal sigmoidostomy were effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.

Objective To discuss the diagnosis and treatment of pelvic fractures associated with intra-abdominal organ injuries.Methods The cause of trauma,opreative methods and results of 142 cases of pelvic fractures associated with intra-abdominal organ injuries retrospectively in 15 years were summarized.Results All cases in this group were multiple trauma,and 91 cases were in shock stage(64.1%).The average score of ISS was 35.In the group,103 cases received surgical operation,and 39 cases were treated conservatively.In all,laparotomy was performed in 91 cases,bladder anastomosis or cystostomy was performed in 56 cases,hepatic lobectomy,splenectomy,nephrectomy or renal,spleen,liver packing and/or repair were performed in 45 cases,12 cases received colostomy or colon,rectal anastomosis,bilateral internal iliac artery ligation were performed in 42 cases,selective angiography and embolization were performed in 29 cases.Mortality in this group was 9.2%(13 cases).Conclusion The principles in managing pelvic fractures associated with abdominal organ injuries include increase blood volume immediately,find out the cause of bleeding and stop bleeding with laparotomy,pelvic fixation as soon as possible,combination with radiographic and intervention technology.Accurate early diagnosis and effective early treatment are key points to save life,lower the paralysis ratio and decrease the mortality.