27例闭合性肝外伤的非手术治疗分析  

Analysis of nonoperative treatment of 27 cases with blunt hepatic trauma

作　　者：李进军[1] 胡瑞行[1] 冯跃[2] 

机构地区：[1]武警浙江省总队医院急诊科,浙江嘉兴314000 [2]武警浙江省总队医院普外科,浙江嘉兴314000

出　　处：《中国急救医学》2007年第8期738-740,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的分析探讨闭合性肝外伤非手术治疗方法、效果及适应证。方法总结我科2002-06～2006-06收治的闭合性肝外伤非手术治疗27例,其中肝损伤程度Ⅰ级13例,Ⅱ级10例,Ⅲ级2例,Ⅳ级2例。保守治疗包括积极输液、止血、输血、抗炎、生长抑素、保肝、ICU监测等,部分患者加介入治疗,包括肝动脉栓塞治疗、B超经皮穿刺置管引流、内镜下逆行胰胆管造影(ERCP)+内镜下鼻胆管引流术(ENAD)。结果保守治疗治愈25例,成功率92·6%(25/27),中转手术治疗2例(1例因肝包膜下血肿破裂出血,1例合并结肠穿孔);并发症3例(胆道出血2例,胆瘘和肝周脓肿1例),均加介入治疗治愈;介入治疗4例(肝动脉栓塞治疗2例,穿刺置管引流1例,ERCP+ENBD1例),全部治愈。结论闭合性肝外伤应根据全身血流动力学情况、肝外伤程度、外伤部位、有无合并伤等因素决定是否手术治疗,多数非手术治疗可治愈。但需在重症监护条件下严密观察、随访,如出现手术指征需及时中转手术。介入治疗和药物生长抑素治疗可增加非手术治疗成功率。Objective To analyze the method, curative effect and indication of nonoperative treatment for blunt hepatic trauma. Methods From June 2002 to June 2006, to summarize the experience of nonoperative treatment of 27 cases with blunt hepatic trauma, including 13 cases of Ⅰ grade trauma, 10 cases of Ⅱ grade trauma, 2 cases of Ⅲ grade trauma, 2 cases of Ⅳ grade trauma. The nonoperarive treatment included transfusion, hemostasis, blood transfusion, anti -inflammatory therapy, somatostatin, liver protection, ICU monitoring. Partial patients also accepted intervention treatment which included the embolism of hepatic artery, percutaneous transhepatic cholangiographic drainage （ PTCD ） , endoscopic retrograde cholangio - pancreatography （ERCP） ＋ endoscopic nasobiliary drainage （ ENBD）. Resuits The 25 cases were cured. The successful rate was 92.6% （25/27 ）. 2 cases transferred to operation, including 1 case with hepatic hematoma rupture and 1 cases with perforation of colon. 3 cases suffered froth the complications, including 2 cases with hemobilia, 1 case with biliary fistula and 1 case with perihepatic abscess. All the 3 cases were cured by the intervention treatment. Among 4 cases with intervention treatment, 2 cases underwent embolism of hepatic artery, 1 case underwent PTCD and Ⅰ case underwent ERCP ＋ ENBD. All the 4 cases were cured. Conclusion For the patients with blunt hepatic trauma, the hemodynamics, the injure grade and the position of the trauma, and compound injury should be thought to decide whether the operation is necessary. Most of the patients can be cured by nonoperative treatment, but all the patients should be monitored closely in ICU. If the operative indication appears the patient should be transferred to operation in time. Intervention treatment and somatostatin can increase the successful rate of nonoperative treatment.

关 键 词：闭合性肝外伤 非手术治疗 介入治疗 生长抑素 

分 类 号：R657.3[医药卫生—外科学]