摘要
外伤性肝破裂可分为钝性闭合伤和锐性穿透伤,大多数钝性闭合伤可依据CT进行诊断,创伤超声重点评估法(focused assessment sonography in trauma,FAST)可迅速判断院前或急诊复苏时是否需行急诊手术,腹腔镜对实施开腹或非开腹治疗具有决策价值。外伤性肝破裂主要依据临床表现、FAST、CT和术中所见进行分级评估,酌情选择适宜的治疗方式。治疗方式包括①非手术治疗主要用于血流动力学稳定、无腹膜炎征象的伤员;②腹腔镜手术主要用于Ⅲ级以下部分伤员;③一次性确定性开腹手术主要用于受伤至手术时间较短、生理机能破坏程度较轻、未合并其他脏器伤、或虽合并其他脏器伤但程度较轻的伤员;④损伤控制性手术主要用于受伤至手术时间长、合并肝外胆管、胰腺、十二指肠等其他重要脏器损伤,出现致死性三联征的休克伤员。Ⅲ~Ⅴ级伤员接受外科治疗术后可发生肝破裂处再次出血、肝实质坏死、胆瘘、胆道出血、假性动脉瘤、动静脉瘘、创伤性胆汁瘤、继发性肝脓肿等并发症,需及时发现并采取恰当治疗方式,才能保障伤员安全康复。
Traumatic liver rupture can be divided into blunt closed injuries and sharp penetrating injuries.Most of the blunt closed injuries can be diagnosed by computed tomography(CT)scanning.Focused assessment sonography in trauma(FAST)can be used to quickly determine whether emergency surgery is needed during prehospital or emergency resuscitation,and laparoscopy is of practical value in making decisions about laparotomy.Traumatic liver rupture was evaluated according to clinical manifestations,FAST,CT and intraoperative findings,and appropriate treatment was selected as appropriate.Treatment methods include:①Nonoperative treatment:it was mainly used for hemodynamically stable casualties without signs of peritonitis.②Laparoscopic surgery:it was mainly used for some casualties with grade I and II hepatic injuries;③One-time definitive laparotomy:it was mainly used for casualties with a short period of time from injury to surgery,with less physiological damage and no or slight injuries of other organs.④Damage control surgery:it was mainly used for shock casualties with long time from injury to surgery,complicated with injuries of extrahepatic bile duct,pancreas,duodenum or other important organs,and casualties with lethal triad.Complications such as rebleeding at the ruptured liver,parenchymal necrosis,biliary fistula,biliary hemorrhage,pseudoaneurysm,arteriovenous fistula,traumatic biliary aneurysm,secondary liver abscess and so on can occur after operative management.Therefore,timely detection and appropriate treatment are needed to ensure safe recovery for casualties with grade III~V injuries.
作者
尚丹丹
刘燕
尚培中
马丽琼
SHANG Dan-dan;LIU Yan;SHANG Pei-zhong;MA Li-qiong(Department of General Surgery,The 81<st> Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China;Department of Critical Care Medicine,The 81<st> Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China)
出处
《河北北方学院学报（自然科学版）》
2022年第2期40-45,共6页
Journal of Hebei North University:Natural Science Edition
基金
张家口市大健康和生物医疗专项重点研发计划项目(No.2021048D)。
关键词
创伤
外伤性肝破裂
诊断
治疗
损伤控制性手术
trauma
traumatic liver rupture
diagnosis
treatment
damage control surgery
