腹部闭合伤致肝破裂37例诊治分析  

Analysis of Clinical Diagnoseis and Treatment of 37 Cases of Broken Liver Resulted from Shut Abdominal Injury

作　　者：梁春林[1] 肖钟迪[1] 康德新[1] 郭忠武[1] 殷响[1] 张奇兵[1] 

机构地区：[1]大庆油田总医院普外科,黑龙江大庆163001

出　　处：《中国伤残医学》2008年第6期25-27,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:分析诊治腹部闭合伤致肝破裂的临床疗效。方法:回顾性分析用不同方法治疗腹部闭合伤致肝破裂37例。根据患者情况,行保守治疗8例,手术治疗29例,其中有3例为保守治疗后行手术,根据肝损伤的情况选择如下术式:(1)清创止血,肝褥式单纯缝合修补术15例。(2)清创缝合加肝动脉结扎术2例。(3)清创性肝切除术+肝实质或肝旁大血管缝扎术或修补术1例。(4)清创加带蒂大网膜塞止血加明胶海绵6例。(5)局部清创止血+修补缝合+肝实质或肝旁大血管缝扎术或修补术2例。(6)肝周纱布填塞术2例。均附加腹腔引流。结果:治愈38例,因脑外伤致1例死亡。并发症:术后出现并发症5例,胆汁瘘1例,膈下脓肿1例,应急性溃疡1例,肺感染1例,胆道出血1例。均治愈。结论:除据病人病史症状外,诊断性腹腔穿刺,B超及CT检查是对腹部闭合伤致肝破裂早期诊断的有效手段。保守治疗基于对生命体征的严密观察及积极的基础治疗。具体的手术方法根据肝脏损伤情况,有效止血,清除失活组织及充分引流决定。Objective：To explore the diagnosis and management of broken liver due to shut abdominal injury. Methods： Thirty seven cases with 23 males and 14 females were reviewed. A--mong them there were eight cases were provide conservative treat- ment and other 29 were offer surgical treatment. Results： There were 8 were cured in conservative treatment cases and 3 were transfored for surgery in 29 of surgical operation group, and total 38 patients were cured and 1 were died in surgery group because of brain injury. The methods of operations： liver simple suture, hepatic artery ligation, partial hepatectomy, to repair liver and the big blood vessel sews up and liver plugging. Sufficient drainages were established in the process of operations. Conclusion.. （1） The diagnosis belly cavity to stab and B ultrasonic and CT to check should be the important meaning in liver broke due to shut ab- dominal injury. （2） Therapeutic methods were taken depending on the vital signs and degree of injury. Conservative treatment in the Ⅰ--Ⅱ class injury based on blood dynamics stability tight observe and the basic keep treatment. （3） Methods of operation based on to stop bleeding, debride dead hepatic tissue and sufficient drainages.

关 键 词：腹部闭合伤 肝破裂 诊断 治疗 

分 类 号：R656[医药卫生—外科学]