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非貫通性 腹部外傷으로 因한 備藏破裂의 臨床的 觀察

A Clinico-Statistical Review of Nonpenetration Spleen Pupture

대한외과학회지 1970년 12권 4호 p.1 ~ 12
睦敦相, 崔弘益,
소속 상세정보
睦敦相 (  ) - 友石大學校 醫科大學 一般外科學敎室
崔弘益 (  ) - 友石大學校 醫科大學 一般外科學敎室

Abstract


This reports a Clinico-statistical review of experience with 42 cases of nonpenetrating injuries of abdomen causing rupture of spleen, which were treated surgically at the Woo Sok University Hospital from January, 1963, to April, 1969.
1) Among nonpenetrating injuries of abdomen causing rupture of intra-abdominal organs, 204 cases, small intestinal perforation was the commonest incidence, involving 46 cases (22.6%), and the spleen rupture, 2nd in incidence involving 42 cases (20.6%), and the remaining cases were 39 of kidney, 37 of liver, 20 of mesenterium, 17 of uninary bladder, 2 of stomach, and 1 of colon.
2) The sex distribution assumed a ratio of 5 to 1 with 33 males and 9 females.
3) The age distribution indicated a predominant incidence in 2nd and 4th decade (each, 26.2%).
4) As the causes, automobile accident was in 36 cases (85.7%), falling in 4 (9.5%), and blow and kick in 2 (4.8%).
5) 11 cases (26.1%) of our patients sustained injury to the spleen alone, and the remaining 31 cases (73.9%) had serious associated injuries. Fracture of ribs was the commonest associated injury, 19 cases (45.2%), and fracture of the left ribs was in 9 cases (21.4%).
The associated injury of the intra-abdominal organ was in 20 cases (47.6%), the commonest one of which was liver injury 8 cases (19.1%).
6) Symptoms and physical findings were variable, related closely to condition of each patient and associated injuries. But the abdominal pain was in 33 cases (87.6%), abdominal tenderness in 36 (85.7%), abdominal rigidity in 38 (90.4%).
7) Shock was in 13 cases (20.9%), and systolic pressure below 100 mmHg, in 24 (57.1%), the pulse rate over 100/min, in 28 (66.7%).
8) At admission time, complete blood count, especially, hematocrit and leucocyte count were valuable in diagnosis. Hemoglobin count below 11.0 gm% was in 21 cases (50%). The hematocrit below 40 was in 34 cases (81%), The hematocrit below 35, in 24 (57.2%). The leucocytosis was in 35 cases (83.4%) and the count over 15,000/㎣ was in 28 cases (66.7%).
9) Peritoneal tap to determine the presence of free blood was diagnostic in our reports. The positive finding was in 37 cases (88.1%).
10) Among 36 cases checking X-ray of chest and abdomen, the suggestive finding of spleen rupture was only in 12 cases (33.3%).
11) 28 cases (68.1%) were operated with in 12 hours from trauma, and the delayed rupture over 48 hours from trauma was in 8 cases (19.1%).
12) The single laceration of diaphragmatic surface of spleen was the commonest character of spleen rupture, 23 cases (60.6%).
13) The splenectomy was undergone to all 42 cases.
14) The postoperative complication was in 15 cases (35.7%), and the commonest one was adhesive ileus, 5 cases (11.9%).
15) Postoperative death was in 6 cases (14.3%). The mortality was deeply related to other associated injuries. In the spleen injury alone, the death rate was 9.1%, but in the cases complicated by serious associated injury, the rate was 16.1%. In the spleen rupture, not associated by concomitant intra-abdominal injury, the death rate was 4.5%, but in concomitant injury of one intra abdominal organ, the death rate was 17.6%, and in 2 intra-abdominal concomitant injury, the death rate, 66.7%. The pulse rate, blood pressure and hematocrit was valuable in evaluation of prognosis.

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