成人钝性肝损伤非手术治疗评价  

Nonoperative management of adult blunt hepatic injury

作　　者：赵景明[1] 蔺锡侯[1] 李文东[1] 

机构地区：[1]北京积水潭医院外科,100035

出　　处：《中华普通外科杂志》2005年第8期519-520,共2页Chinese Journal of General Surgery

摘　　要：目的评价成人钝性肝损伤非手术治疗的结果。方法对1982年10月至2002年10月收治的132例成人钝性肝损伤进行分析,其中非手术治疗34例,占全部病例25·8%,诊断除病史外1995年以前辅以腹腔穿刺或B超检查,部分患者行CT检查。1995年以后全部辅以CT检查。手术治疗98例。结果以1995年前后为界,非手术治疗率分别为16·7%(14/84)和41·7%(20/48)(χ2=9·98,P<0·01),非手术治疗成功率94·1%。手术治疗组中手术时肝损伤创面已无活动出血仅单纯引流病例分别为21·4%(15/70)和10·7%(3/28)(χ2=1·53,P>0·05)。结论应用CT扫描以及血液动力学监测,在严格选择适应证的情况下,某些成人钝性肝损伤病例是可以采用非手术治疗的。Objective To evaluate nonoperative management of adult blunt hepatic injury. Method The outcome of 132 cases with adult blunt hepatic trauma admitted in this hospital between Oct 1982 and Oct 2002 was analyzed. Thirty-four cases （ 25.8% ） were treated by nonoperative management. Before 1995, only a portion of patients underwent CT scan and after 1995, diagnosis of liver injury was established by CT scan in all cases. Result The nonoperative management rate before 1995 was 16. 7% （14/84） and after 1995, it was 41.7% （20/48）（P 〈0. 01 ）. Nonoperative management was successful in 94. 1% patients undergoing this modality. Before 1995, 21.4% （15/70） patients underwent laparotomy only compared with 10. 7% （ 3/28 ） after 1995 （ P 〉 0. 05 ）. Conclusion With the progress of image monitoring and life support system, some patients of blunt hepatic injury could be managed by conservation therapy.

关 键 词：成年 钝性肝损伤 非手术治疗 血液动力学 B超检查 CT检查 

分 类 号：R657.3[医药卫生—外科学]