查詢結果分析
來源資料
頁籤選單縮合
題 名 | Early Diagnosis of Duodenal Injury: A Review of Eleven Cases=十二指腸外傷的早期診斷:十一個病例回顧 |
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作 者 | 楊智傑; 施信嶔; 林裕冠; 吳哲侃; 柯敦仁; 蘇正熙; 李建賢; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 31:3 民87.05-06 |
頁 次 | 頁187-191 |
分類號 | 416.243 |
關鍵詞 | 十二指腸外傷; Duodenal injury; Sonogram; CT scan; Diagnostic peritoneal lavage; |
語 文 | 英文(English) |
中文摘要 | 十二指腸外傷的早期診斷是困難的,本篇報告回顧本院過去之經驗並找尋有關早 期診斷的臨床徵候。從 1990 年一月到 1995 年十二月,我們回顧所有十二指腸外傷病人之 病歷。對於他們的診斷、治療,與臨床結果進一步分析,結果發現總共有十一個病例;四個 穿透傷,七個鈍傷,三個鈍傷病人有延遲診斷(超過二十四小時),早期缺乏腹部徵候,加 上正常超音波和診斷性腹膜透析術是主要延遲診斷之原因。這些延遲診斷的病人,最後皆因 臨床徵候變明顯或後續的胰臟脢的上升,而藉由電腦斷層診斷出十二指腸外傷。所以電腦斷 層診斷出三個十二指腸外傷( 3/3 ), 超音波(經由游離液體存在與否)誤診五個病人( 5/10 ),診斷性腹膜透析術誤診一個病人( 1/2 )。結論:早期缺乏明顯腹部徵候,加上 正常超音波或診斷性腹膜透析術,是十二指腸外傷延遲診斷之主要原因。高度臨床懷疑,儘 管腹部徵候輕微,胰臟脢的追蹤,以及輔助性的使用腹部電腦斷層是避免延遲診斷的最好方 法。 |
英文摘要 | Early diagnosis of duodenal trauma in injured patients is difficult. We reviewed our experience in the management of duodenal injury and searched for clinical implications enabling early diagnosis in the present study. The medical records of injured patients with duodenal trauma treated between January 1990 and December 1995 were reviewed. Their diagnosis, treatment, and outcome were analyzed. Eleven patients were enrolled; four with penetrating injuries and seven with blunt injuries. Three patients had delayed diagnosis (more than 24 hours after injury). Initial absence of overt peritoneal sign with negative sonogram or diagnostic peritoneal lavage (DPL) was the main cause of delay. The delayed cases were finally diagnosed by CT scan for deteriorated abdominal condition or subsequent elevated amylase level. While CT scan found three duodenal injuries including one duodenal hematoma (3/3), sonogram missed five (5/10), and DPL missed one (1/2). In conclusion, initial absence of overt abdominal sign with negative sonogram or DPL will not exclude duodenal injury. High clinical suspicion even in trifling signs of abdomen, repeating amylase level, and complementary use of CT scan will decrease the catastrophe of delayed diagnosis. |
本系統中英文摘要資訊取自各篇刊載內容。