摘要
目的探讨肝外伤的诊断和治疗方法。方法回顾性分析160例肝外伤患者的临床资料，其中闭合性肝损伤96例和开放性肝损伤64例。结果160例肝外伤中1例Ⅳ级伤因合并严重胸廓挤压伤入院后30min内死亡，其余159例中Ⅰ～Ⅲ级损伤45例（I级9例，Ⅱ级31例，Ⅲ级5例），采用非手术治疗，并发症4例（8．9％），均治愈，治愈率100％；手术治疗114例，其中Ⅱ级7例，Ⅲ级67例，Ⅳ级20例，Ⅴ级8例，Ⅵ级12例，治愈112例（98．2％），发生各类并发症共7例（6．1％）：术后并发ARDS死亡1例，术后再出血2例（1例死亡，1例痊愈）；另肝脓肿2例，胆瘘2例，经治疗痊愈。死亡2例（1．8％）。结论对肝外伤诊断的检查应以腹腔穿刺加B超为首选，条件允许时可行腹部CT检查。对血液动力学稳定的Ⅰ和Ⅱ级、部分Ⅲ级损伤可在严密监测下行保守治疗；部分Ⅱ级损伤、大部分Ⅲ级损伤、所有Ⅳ～Ⅵ级损伤以行手术治疗为宜。
Objective To explore the diagnosis and treatment of liver trauma. Methods A retrospectively analysis of clinical data of 160 cases of liver trauma, including 96 cases of blunt trauma and 64 cases of open trauma, was made. Results Among the 160 cases, one case with stage IV trauma and severe thoracic injury died 30min after admission. Among the other 159 cases, 45cases （9 cases of stage Ⅰ, 31 cases of stage Ⅱand 5cases of cases Ⅲ ） received nonoperative treatment, and 114cases （7 cases of stage Ⅱ, 67 cases of stage Ⅲ and 50 cases of stage Ⅳ ） received operative therapy. In non-operative treatment group, the cure rate was 100 % （45/45）. In operation treatment group the cure rate was 98.2 % （112/114） , the mortality rate was 1. 8 % （2/114 ） , 1 case died of hemorrhage after operation and 1 case died of ARDS. Five patients with postoperative complications were cured, including hepatic abscess in 2 cases, biliary fistula in 2 cases, and hemorrhage after operation in 1 case. Conclusions B-ultrasound is the method of choice for diagnosis of liver trauma, and CT can be used if conditions permit. Cases of lives truma of stages Ⅰ and Ⅱ and some cases of stage Ⅲ that have stable hemodynamics, can receive nonoperative treatment under close observation. Some cases of stage Ⅱ , most cases of stage Ⅲ and all cases of stages IV to Ⅵ injury should oreferably undergo surgical treatment.
出处
《中国普通外科杂志》
CAS
CSCD
2007年第12期1174-1177,共4页
China Journal of General Surgery
