严重外伤性肝破裂手术治疗25例分析  

Surgical treatment of severe traumatic hepatorrhexis in 25 patients

作　　者：周健[1] 黄绪广 毕建威[1] 聂明明[1] 

机构地区：[1]第二军医大学附属长海医院普通外科,上海200433

出　　处：《中华肝脏外科手术学电子杂志》2016年第1期29-31,共3页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨手术治疗在严重外伤性肝破裂患者中的应用价值。方法回顾性研究2009年10月至2013年10月在第二军医大学附属长海医院接受手术治疗的25例外伤性肝破裂患者临床资料。其中男17例,女8例;平均年龄(35±10)岁。美国创伤协会分级Ⅳ级17例,Ⅴ级5例,Ⅵ级3例。所有患者均签署知情同意书,符合医学伦理学规定。所有患者入院后均给予积极术前准备,在气管插管全身麻醉下行急诊手术治疗。其中行不规则肝切除术20例,规则肝叶段切除术1例,全肝血流阻断下肝后下腔静脉修补术3例,肝周纱布填塞治疗1例。结果本组患者治愈23例,死亡2例,均死于失血性休克;发生术后并发症6例,其中膈下脓肿3例,胆漏1例,胸腔积液1例,切口感染1例,均于对症处理后治愈。结论严重外伤性肝破裂患者应尽快手术止血,手术方式首选不规则肝切除术。Objective To investigate the application value of surgical treatments for severe traumatic hepatorrhexis patients. Methods Clinical data of 25 patients with severe traumatic hepatorrhexis receiving surgical treatments in Changhai Hospital of Second Military Medical University from October 2009 to October 2013 were retrospectively analyzed. There were 17 males and 8 females with the average age of（35±10） years. According to the injury scale of American Association for the Surgery of Trauma, 17 cases were divided as grade Ⅳ, 5 as grade Ⅴ and 3 as grade Ⅵ. The informed consents of all patients were obtained and the local ethical committee approval had been received. Full preparation was made prior to surgery. All patients underwent emergency surgery under general anesthesia via intubation. Twenty patients received irregular hepatectomy, 1 underwent regular hepatectomy, 3 received repair of retrohepatic inferior vena cava under total hepatic vascular exclusion and 1 was treated with perihepatic gauze packing. Results Twenty-three cases were cured, and 2 died from hemorrhagic shock. Six cases developed postoperative complications including 3 with subphrenic abscess, 1 with biliary leakage, 1 with pleural effusion and 1 with wound infection. All were cured after symptomatic treatments. Conclusions Surgical hemostasis should be performed immediately for patients with severe traumatic hepatorrhexis. Irregular hepatectomy is the primary surgical procedure.

关 键 词：破裂 治疗学 肝疾病 

分 类 号：R657.3[医药卫生—外科学]