成人钝性肝损伤的非手术治疗  

Nonsurgical management of blunt liver injury in adult patients

作　　者：董志涛[1] 罗昆仑[1] 方征[1] 刘洪[1] 张伟杰[1] 李界明[1] 

机构地区：[1]解放军第一0一医院普通外科,江苏无锡214044

出　　处：《中国普通外科杂志》2011年第7期740-742,共3页China Journal of General Surgery

摘　　要：目的评价成人钝性肝损伤非手术治疗的效果。方法回顾性分析近6年间非手术治疗96例成人钝性肝损伤患者的临床资料。其中肝外伤I级者51例(53.1%),Ⅱ级30例(31.3%),Ⅲ级12例(12.5%),Ⅳ级3例(3.1%)。诊断包括病史、超声检查,腹腔穿刺及CT检查。入院后监测生命体征,并给予对症支持治疗。结果非手术治疗成功87例,成功率90.6%,中转手术治疗9例。共发生并发症15例,包括右侧胸腔积液12例,肝周脓肿3例,经对症处理后均痊愈。结论对钝性肝损伤施行非手术治疗是可行的;严格选择适应证、注意监测血流动力学、超声及CT等辅助检查,是提高成功率的关键。Objective To evaluate the efficacy of nonsurgical management for blunt hepatic injury in adult patients.Methods The clinical records of 96 adult patients with blunt hepatic injury undergoing nonsurgical treatment at our hospital during the past 6 years were retrospectively analyzed.Of the patients,the hepatic injury grade was 51（53.1%） in grade I,30（31.3%） grade II,12（12.5%） grade Ⅲ and 3（3.1%） grade Ⅳ.Diagnosis was based on the history,ultrasonic examination,abdominal paracentesis and CT scan.All patients had monitoring of vital signs and were given symptomatic relief and supportive treatment.Results Nonsurgical management was successful in 87 patients（90.6%） and 9 patients were converted to operation.Complications occurred in 15 cases,which included 12 right pleural effusions and 3 perihepatic abscesses.All these complications resolved with non-surgical symptomatic treatment.Conclusions Nonsurgical management is feasible for adult patients with blunt hepatic injury.However,strictly defined indications and precise hemodynamic monitoring along with ultrasonic and CT examination are all critical factors for improving the success rate.

关 键 词：肝/损伤 创伤和损伤/治疗 预后 

分 类 号：R657.3[医药卫生—外科学]