非手术治疗在Ⅳ级 V级闭合性肝破裂中临床应用  

作　　者：陈刚红 江克翔 陈铁炯 许秀丽 

机构地区：[1]浙江省诸暨市人民医院,311800

出　　处：《浙江临床医学》2017年第1期4-6,共3页Zhejiang Clinical Medical Journal

基　　金：2012浙江省绍兴市科技计划（2012d10013）

摘　　要：目的观察非手术治疗在Ⅳ、V级闭合性肝破裂中应用价值。方法分析bk2011年1月至2013年1月连续27例1V级、V级闭合性肝破裂患者，根据入院时血流动力学情况及腹膜炎情况分为非手术治疗组和急诊手术治疗组，比较两组患者年龄、性别、输血量、肝破裂分级情况、并发症及病死率的差异。结果（1）27例患者中，非手术治疗组9例，平均年龄（42．78±15．25）岁，急诊手术组18例，平均年龄（28．45±6．74）岁，两组比较差异无统计学意义（t=1．94，P=0．064）；（2）非手术治疗组男、女比例为3：4，急诊手术组男、女比例为15：5，两组比较差异无统计学意义（P=0．175）；（3）AAST分级Ⅳ级12例、V级15例。非手术治疗组Ⅳ级5例、V级4例，手术治疗组1V7例、V级11例，两组比较差异无统计学意义（P=0．448）；（4）非手术治疗组输血量0-16U，平均（3．56±2．53）u，手术治疗组输血量3-34U，平均（15．27±4．66）u，两组比较差异有统计学意义（t=3．31，p=0．003）。（5）非手术治疗组并发症2例，手术治疗组术后并发症11例，两组比较差异无统计学意义（P=0．103）；（6）非手术治疗组无死亡病例，急诊手术组死亡8例。结论对于Ⅳ级和V级闭合性肝破裂，如患者生命体征稳定，无明显腹膜炎症状，非手术治疗是可行的，可以减少输血和病死率，但严重肝破裂出现并发症的几率较高，需要使用有创方法比如肝动脉栓塞、穿刺引流或者ERCP等甚至手术的介入。Objective To evaluate the role of nonoperative management （ NOM ） for patients with grade 1V and V blunt hepatic injuries. Methods A analysis was made on patients who presented with grade IV and V blunt hepatic injuries were admitted at our institution between January 201 l and January 2013.The patients who witla hemodynamic stability and no sings of peritonitis were nonoperative management, and the others were operative management （ OM ） . The age, gender, grade of injury according the American Association for the Surgery of Trauma （ AAST ） , blood transfusion, the complications, and the mortality were analyzed. Result Between January 2011 and January 2013, 27 patients were admitted with grade IV and V blunt hepatic injuries. Nine patients （ 33% ） were treated with NOM and eighteen patients were with OM. The age （ 42.78 ± 15.25 years in NOM vs 28.45 ± 6.74 years in OM, t=-1.94, P=0.064 ） , the gender （ m/f, 3/4 in NOM vs. 15/5 in OM, Fisher＇s test=0.175 ） , the grade ofAAST （ 1V/V, 5/4 in NOM vs. 7/11 in OM, Fisher＇s test=-0.448 ） and the complications （ 2/9 in NOM vs. 11/18 in OM, Fisher＇s test=0.103 ） were no significant differences. The blood transfusion （ 3.56 ± 2.53U in NOM vs. 15.27 ± 4.66U in OM, t=3.31, P=0.003 ） was significant differences. No death occurred in NOM, and there was 8 deaths in OM. Conclusion NOM is a safe and effective method for patients with hepatic injury who were hemodynamic stability and no sings of peritonitis. NOM can reduce the number of transfusions and the mortality, but complications in grade 1V and V injuries should be anticipated and may require a combination of nonoperative management strategies and operative management.

关 键 词：闭合性肝破裂 非手术治疗 肝动脉栓塞 

分 类 号：R657.32[医药卫生—外科学]