肝外伤的诊治体会（附55例报告）  

Diagnosis and treatment of hepatic trauma： a report of 55 cases

作　　者：张吉成[1] 陈燕凌[1] 

机构地区：[1]福建医科大学附属协和医院肝胆外科,福州350001

出　　处：《国际外科学杂志》2009年第2期78-80,共3页International Journal of Surgery

摘　　要：目的总结肝外伤的诊断和治疗经验。方法回顾55例肝外伤患者的临床资料。结果55例肝外伤中Ⅰ～Ⅱ级18例，Ⅲ级15例，Ⅳ级17例，Ⅴ级5例；采用非手术治疗31例，均痊愈；手术治疗24例，痊愈22例，自动出院2例。结论肝外伤诊断以全腹B超和腹腔穿刺为首选检查，血液动力学稳定时可行腹部CT平扫或加增强扫描对判断是否行手术治疗有帮助。目前，肝外伤的治疗主要考虑两个方面：血液动力学的稳定性和外伤的性质：钝挫伤或贯通伤；在判断是否行保守治疗时，血液动力学稳定性比肝外伤分级相对更重要。对血液动力学稳定的Ⅰ级、Ⅱ级和部分Ⅲ级钝性肝外伤可在严密连续监测下行非手术治疗；根据血液动力学变化和伤情判断及时中转手术；对血液动力学不稳定的部分Ⅲ级、Ⅳ级和Ⅴ级严重肝外伤以手术治疗为宜。早期复苏、有效止血、充分引流和防治术后并发症是降低严重肝外伤病死率的关键。Objective To summarize the experiences of the diagnostic and therapeutic approach of hepatic trauma. Methods Referencing to the literature of recent years, we retrospectively analyzed the clinical data of 55 cases of liver trauma. Results Among the 55 cases,18 cases of stage I - II , 15 cases of stage m, 17 cases of stage IV and 5 cases of stage V, Thirty-one cases received non-operative treatment, and 24 cases received operative therapy. In non-operative treatment group,the cure rate was 100%. In operation treatment group the cure rate was 91.7%. Conclusions Focused ahdominal sonography for trauma（FAST） and diagnostic peritoneal paracentesis are the initial methods for diagnosis of liver trauma and are largely used nowadays. When the patient is hemodynamically stable, CT scan or simultaneous contrast-enhanced scan are important to decide for conservative or surgical treatment. Today, treatment of hepatic lesions takes in account mainly two aspects： hemodynamically stability and the mechanism for trauma （blunt or penetrat- ing）. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management. Nonoperative management under close continuous observation for the hemodynamically stable patients with stage I and II and some cases of stage III blunt hepatic injury has become the standard of care. The decision for surgical intervention should be given in time according to the variance of hemodynamically stability and the presence of trauma （ blunt or penetrating）. Some cases of stage m and all cases of stage IV to V hepatic injury should preferably undergo surgical treatment. The effective preventive measures to decrease mortality in patients with severe hepatic trauma include early remedy to hemorhagic shock, effective hemostasis, complete abdominal drainage and prevention of postoperative complications.

关 键 词：肝外伤 诊断 外科手术 保守治疗 

分 类 号：R657.3[医药卫生—外科学]