严重肝外伤救治.doc

严重肝外伤救治 　 作者：霍景山，陈积圣，陈汝福，张斌 【摘要】 目的 总结严重肝外伤的处理经验。方法 对1991年1月~2007年5月经治的32例严重肝外伤患者的临床资料，包括损伤程度、手术方式、疗效及术后并发症进行分析。结果 肝外伤Ⅲ级16例，Ⅳ级11例，V级5例。行单纯修补缝合6例；大网膜填塞加缝合9例；明胶海绵填塞加缝合6例；纱布填塞3例；不规则肝段切除7例，规则右半肝切除1例。痊愈25例，死亡7例，其中死于大血管破裂失血性休克4例，死于颅脑外伤、肝创面再出血及多器官功能衰竭各1例。8例发生近期并发症，其中再出血2例，均再次手术止血。膈下感染2例，胆漏1例，肝脓肿1例，应激性溃疡1例，急性肾衰1例。结论 尽快救治失血性休克，术中彻底止血，充分引流，预防术后并发症，是治疗严重肝外伤的有效措施。 【关键词】 肝外伤；外科手术； 治疗 Abstact Objecive To summarize the experiences of surgical treatment on severe hepatic trauma. Methods From January 1991 to May 2007， the clinical data of 32 patients with severe hepatic trauma were summarized retrospectively， including injury degree， operative type， effects and postoperative complications. Results There were 16 cases in grade Ⅲ， 11 cases in grade IV， 5 cases in grade V in the hepatic traumatic patients. Six cases were undergone simple suturing. 9 cases suturing and tamponing with greater omentum， and 6 case with gelatin sponge. 7 cases non-anatomical hepatic segmentectomy， and one case with anatomical hepatic segmentectomy. Twenty-five cases were cured and 7 cases died. Four cases died of hemorrhage， one died of multiple organ function failure, one died of craniocerebral trauma and one died of hepatic traumatic surface rehaemorrhagia. The overall mortality was 21.87%. Operative complication occurred in 25% of the patients， included 2 cases of re-bleeding， 2 cases of infra-diaphragmatic infection， one of bile leakage， one of stress ulcer and one with acute renal failure. Conclusion The effective preventive measures to decrease mortality in patients with severe hepatic trauma include early remedy to hemorrhagic shock， effective stop bleeding， complete abdominal drainage and prevention of postoperative complications. Keywords hepatic trauma； surgery； treatment严重肝外伤的病情凶险， 治疗棘手，并发症多，病死率较高。1991年1月～2007年5月，笔者共经治严重肝外伤32例，现将救治体会报告如下。 1 资料和方法 1.1 一般资料 本组男25例，女7例；年龄5～48岁。其中开放性损伤5例（均为刀刺伤），闭合性损伤27例（车祸伤20例、钝器击伤4例、坠落伤3例）。损伤位于肝右叶伤20例，肝左叶伤9例，两叶损伤2例，尾状叶1例。其中5例合并大血管损伤，裂伤程度均gt;3 cm。有合并伤者16例，其中肋骨骨折