108例严重肝脏损伤诊治分析  

Diagnosis and treatment of 108 cases of severe liver injury

作　　者：向江侠[1] 胡平[1] 高劲谋[1] 

机构地区：[1]重庆市急救医疗中心创伤科,重庆400014

出　　处：《创伤外科杂志》2014年第4期317-319,共3页Journal of Traumatic Surgery

摘　　要：目的总结严重肝脏损伤诊治经验,提高救治水平。方法对2005年1月-2013年12月收治的108例严重肝脏损伤的患者资料进行回顾性分析,男性72例,女性36例;年龄15-75岁,平均（37.0±0.7）岁。道路交通伤55例,坠落伤28例,锐器伤15例,塌压伤5例,摔伤3例,击打伤2例。结果早期诊断正确率94.4%（102/108）,救治成功率89.8%（97/108）,肝脏损伤非手术治疗AE止血有效率为88.9%（8/9）;并发术后出血5例、膈下感染4例、胆瘘11例、胆汁瘤6例,腹腔间隙综合征（ACS）5例,存在并发症的患者2例死亡,余经手术治愈或自愈。总死亡率10.2%（11/108）,死因为失血性休克4例,脑伤3例,胸伤2例,腹腔间隙综合征2例。结论及时正确的伤情评估、合理掌握非手术和手术的指征、正确的选择手术方式、合理运用损害控制策略和肝周填塞对提高救治水平有重要意义。Objective To summarize the experience in the diagnosis and treatment of severe liver injury and to improve the treatment level. Methods The data of 108 patients with severe liver injury from Jan. 2005 to Dec. 2013 were retrospectively analyzed. There were 72 males and 36 females, with an average age of （37.0 ± 0. 7 ） years（ranging from 15 to 75 years old）. There were 55 cases of traffic accident injury,28 cases of falling from height, 15 cases of sharp instrument injury ,5 cases of crush injury, 3 cases of falling injury, and 2 cases of beating injury. Results The early diagnostic accuracy rate was 94.4% （ 102/108 ） , the treatment success rate was 89. 8% （97/108） , the effective rate of bemostasis for liver injuries with non-surgical treatment was 88.9% （8/9）. The postoperative complications included bleeding in 5 cases, subphrenic infection in 4 cases, biliary fistula in 11 cases, biliary tumors in 6 cases and abdominal compartment syndrome （ ACS ） in 5 cases. Two patients with the above complications died. The total mortality was 10. 2% （11/108） ,4 cases died because of hemorrhagic shock,3 cases because of brain injuries ,2 cases because of chest injuries, and 2 cases because of abdominal compartment syndrome （ACS）. Conclusion Timely and correct injury assessment, appropriate management of conservative and surgical indications, correct choice of surgical approach, rational application of damage control strategy and peripheral hepatic tamping are important to improve the treatment level.

关 键 词：肝脏损伤 填塞 损害控制外科 

分 类 号：R657[医药卫生—外科学]