肝外伤诊断和治疗的改进  

Improvement in Diagnosis and Treatment of Hepatic Injury

作　　者：张晓华[1] 徐洁[1] 

机构地区：[1]第二军医大学长海医院肝胆外科

出　　处：《中国普通外科杂志》1998年第2期66-69,共4页China Journal of General Surgery

摘　　要：为探讨钝性肝外伤时改进诊断和治疗对降低并发症和死亡率的影响，分析了１９５１～１９９６年间长海医院１８０例肝外伤的资料。全组有钝性伤１５２例和开放伤２８例。结果显示：腹腔穿刺诊断钝性肝外伤的阳性率为９２．９％（１０５／１１３），急症室超声检查的阳性率为９６．２％（２５／２６）。治疗方法包括３例非手术治疗和１７７例手术治疗。总并发症发生率、治愈率和总死亡率分别为３２．８％（５９／１８０），８５．６％（１５４／１８０）和１４．４％（２６／１８０）。比较前期（１９５１～１９８８年）与近期（１９８９～１９９６年）的资料，通过近年在诊断和治疗上的改进，并发症发生率有显著差异（Ｐ＜０．０５），死亡率有非常显著差异（Ｐ＜０．０１）。讨论了急症室超声检查对钝性肝外伤早期诊断的价值、非手术治疗的利弊。To evaluate the effect of improving diagnosis and treatment for blunt hepatic injury on lowering morbidity and mortality, we analyzed the data of 180 patients with hepatic injury treated in the Changhai Hospital from 1951 to 1996. Among them, there were 152 blunt injuries and 28 open injuries. The results showed that abdominocentesis for blunt hepatic injury had a diagnostic accuracy of 92.9% (105/113), while emergency department ultrasonography of 96.2% (25/26). Treatment consisted of nonoperative (3) and operative (177) modalities. Overall morbidity rate, survival rate and overall mortality rate were 32.8% (59/180), 85.6%(154/180) and 14.4% (26/180) respectively. In comparison of data between 1951～1988 and 1989～1996, it showed a significant difference in morbidity rate (P<0.05) and mortality rate (P<0.01) after modification of the diagnosis and treatment in recent years. The value of emergency department ultrasonography for early diagnosis of blunt hepatic injury, merits and demerits of nonoperative treatment, the choice of operative modality and the prevention of complication are discussed in the paper.

关 键 词：肝外伤 诊断 治疗 并发症 预防 

分 类 号：R657.3[医药卫生—外科学]