非手术治疗肝外伤49例分析  

Clinical analysis of non-operative treatment of hepatic trauma in 49 cases

作　　者：刘延军[1] 曲明[1] 尹惠生[1] 王营[1] 杜英东[1] 张成钧[1] 

机构地区：[1]解放军107医院肝胆外科,山东烟台264002

出　　处：《现代医药卫生》2012年第2期167-168,共2页Journal of Modern Medicine & Health

摘　　要：目的探讨肝外伤非手术治疗的适应证、治疗措施和效果。方法回顾性分析采用非手术治疗49例肝外伤患者资料,其中按美国创伤外科协会分级标准Ⅰ级26例,Ⅱ级19例,Ⅲ级3例,Ⅳ级1例。结果 49例全部治愈,其中非手术治愈46例,占93.88%,包括介入治疗5例(肝动脉栓塞治疗3例,穿刺置管引流2例);中转手术3例,占6.12%,为血肿破裂引起大出血。并发症4例,肝脓肿1例,穿刺置管引流治愈;胸腔积液2例,1例经胸腔穿刺后治愈,1例自行吸收;胆瘘1例,穿刺置管引流治愈。结论对Ⅰ、Ⅱ级及部分Ⅲ级肝外伤患者行非手术治疗安全、可行,血流动力学稳定是治疗的基础,严格掌握适应证是治疗的关键。Objective To explore the indications,treatment measures and effects of surgical therapy in hepatic trauma.Methods The clinical data of 49 patients with hepatic trauma treated by non-operative therapies were retrospectively analyzed.Among them,there were 26 cases of AAST grade I,19 cases of grade Ⅱ,3 cases of grade Ⅲ and 1 case of grade Ⅳ.Results All 49 cases were cured.46 cases were cured by non-operative treatment（93.88%）,including 5 cases of interventional therapy（3 cases of hepatic arterial embolism and 2 cases of percutaneous catheter drainage）.3 cases of massive bleeding caused by hematoma rupturing were converted to operation,accounting for 6.12%.The complications were in 4 cases.1 case of liver abscess was cured by percutaneous catheter drainage.In 2 cases of pleural effusion,1 case was cured after thoracocentesis and another case was voluntarily absorbed.1 case of biliary fistula was cured by percutaneous catheter drainage.Conclusion For grade I,grade Ⅱ and partial grade Ⅲ hepatic trauma,non-operative treatment is safe and feasible.Stable hemodynamics of the patients should be the basis of treatment.The key point of treatment is to strictly master the indications.

关 键 词：肝脏外伤 非手术治疗 分级 

分 类 号：R657.32[医药卫生—外科学]