创伤性肝破裂91例.doc

创伤性肝破裂91例 创伤性肝破裂91例 更新日期：2011-05-11 李小刚　杨连粤　吕新生　李小荣　陈子华 摘　要：目的　分析创伤性肝破裂外科多种干预治疗的效果。　方法　总结1986～1997年本院收治创伤性肝破裂91例。其中Ⅲ级以上严重肝破裂55例(60.4%)。手术治疗78例,手术方式包括单纯修补、清创性肝切除、肝周填塞止血；非手术治疗13例。　结果　手术组中41例发生并发症，均经保守治疗痊愈；死亡7例，其中术中死亡1例。非手术组5例治愈，4例好转，4例失访。　结论　手术是治疗创伤性肝破裂的主要措施，但应根据具体情况,采取个体化手术治疗方案；非手术治疗仅适用于轻型单纯肝破裂。 关键词：创伤和损伤，肝；　破裂，肝；　肝切除术 Surgical treatment of traumatic hepatorrhexis in 91 patients LI Xiaogang, YANG Lianyue, LU Xinsheng，et al. （Dept. of General Surgery, Xiangya Hospital, Hunan Medical University, Changsha 410008, China） Abstract：Objective　To analyze the therapeutic result of traumatic hepatorrhexis treated by different surgical methods.　 Methods　Ninty-one cases of traumatic hepatorrhexis from 1986 to 1997 including 55 cases (59.1%) of severe hepatorrhexis over degree Ⅲ were analyzed in this study. Seventy-eight cases received operative surgery including simple repair, debridement hepatolobectomy and perihepatic-filling hemostasis. Thirteen cases were free of operation. 　Results　 In the operation group, the complications occurred in 41 cases were all cured by conservative treatment. Thirteen cases treated by non-surgical methods resulted in 7 deaths in which one was during the course of operation. In the none-operation group, 5 cases were cured; 4 became well and 4 was free of follow up. Conclusions　Operation is the principal treatment for traumatic hepatorrhexis, non-surgical treatment is just applicable for simple light hepatorrhexis. The surgeons should adopt individual operation scheme to treat different traumatic hepatorrhexis. Key words：Wounds and injuries, liver;　Rupture, liver;　Hepatectomy▲ 　　腹部创伤中肝破裂较为常见,发生率往往超过脾破裂而跃居首位［1］。肝脏破裂常伴有大血管和(或)胆管损伤,外科处理复杂。我院近11年收治创伤性肝破裂91例。报告如下。 资料与方法 一、一般资料 　　1986～1997年,共收治创伤性肝破裂 91例,其中男70例,女21例；平均年龄［27.2±11.8(4～59)］岁。20～40岁60例（65.9%）。闭合性腹部钝性损伤86例（94．5%），开放性锐器损伤 5例（5．5%）。根据美国创伤外科协会制订的肝损伤分级标准［2］,本组Ⅰ级17例、Ⅱ级 19例、Ⅲ级18例、Ⅳ级34例、Ⅴ级 3例，无Ⅵ级病例，Ⅲ级以上严重肝破裂55例(60.4%)。合并其他脏器损伤54例,主要有胸部外伤34例次、骨折30例次、胃肠破裂8例次、肾挫裂伤12例次、颅脑损伤5例次、胆囊损伤2例次、心脏压塞和