严重外伤性肝破裂的手术方式选择  

Operation methods treating severe traumatic hepatic rupture

作　　者：吕俊生[1] 

机构地区：[1]北京市顺义区医院普外二科, 101300

出　　处：《中国医药》2014年第5期677-679,共3页China Medicine

摘　　要：目的 探讨严重外伤性肝破裂的个体化手术方式.方法 回顾分析1999年9月至2013年9月北京市顺义区医院与佳木斯大学第一附属医院收治的35例严重肝外伤患者的临床资料,其中闭合性损伤32例,开放性损伤3例.其中车祸伤21例,高处坠落伤5例,钝物伤5例,刀刺伤4例.35例均合并其他脏器损伤.结果 35例患者术前经腹部B型超声、诊断性腹腔穿刺检查疑诊为肝破裂,均经剖腹探查确诊.严重肝外伤35例中治愈30例,治愈率85.7％;死亡5例,病死率14.3％,其中术中死亡3例,术后死亡2例;术后并发症13例,发生率为37.1％,其中并发术后膈下感染3例,术后肝脓肿2例,术后再出血3例,术后胆瘘3例,术后应激性溃疡出血l例,切口感染l例,均经保守治疗后痊愈.结论 本组严重外伤性肝破裂病例的主要死亡原因为严重合并伤、严重失血性休克.选择合适的手术方式,同时积极地处理合并伤,术中精确止血,预防肝脏继发性出血及胆瘘,建立通畅的外引流,是救治严重肝破裂的关键.Objective To investigate the individualized operation methods treating severe traumatic hepatic rupture.Methods Totally 35 cases who suffered from severe traumatic hepatic rupture were enrolled.The number of closed injury was 32 and open injury was 3.The number of traffic accident injury was 21 and high falling injury was 5.The blunt force injury was 5 and the abdominal stab wound was 4.Results The 35 patients suspected of the traumatic hepatic rupture by abdominal B scan had diagnostic abdominal puncture examination before operation,and they were diagnosed with abdominal laparotomy.Among the 35 cases,30（85.7%） were cured and 5 cases（14.3%） died.3 cases died in operation and 2 cases died after operation.There were 13 cases（37.1%） having complication after operation.The number of the subphrenic infection was 3 ; the liver abscess was 2 ; the rebleeding was 3 ; the biliary fistula was 3 ; the stress ulcer bleeding was 1 and the surgical wound infection was 1.They were cured by conservative treatment.Conclusions Main death causes include the severe associated injuries and the severe hemorrhagic shock.The proper operative method is the key treatment of the severe traumatic hepatic rapture; meanwhile we should deal with the associated injuries,etc.

关 键 词：肝破裂 手术方式 肝切除 并发症 

分 类 号：R657.3[医药卫生—外科学]