儿童腹部闭合性肝脏外伤诊治特点及效果分析  

Characteristics and efficacy analysis of diagnosis and treatment in pediatric abdominal closed liver trauma ina single center

作　　者：季春宜[1] 尹强[1] 陈立健[1] 袁妙贤[1] 彭宇明 谢惟心 盛新仪 Ji Chunyi;Yin Qiang;Chen Lijian;Yuan Miaoxian;Peng Yuming;Xie Weixin;Sheng Xinyi(Department I of General Surgery,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院普外一科,长沙410007

出　　处：《临床小儿外科杂志》2024年第10期952-957,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省科技厅自然科学基金项目(2021JJ40268);湖南省科技厅自然科学基金项目(2023JJ30329);国家临床重点专科建设培育项目-湖南省儿童医院小儿普外科。

摘　　要：目的初步总结儿童肝脏外伤诊治经验,探讨儿童闭合性肝脏外伤的诊治方案。方法回顾性分析2013年1月至2022年12月湖南省儿童医院普外科收治的150例肝脏外伤患儿临床资料,男85例、女65例,年龄(4.66±2.91)岁;依据患儿血红蛋白(hemoglobin,HB)、谷丙转氨酶(glutamic pyruvic transaminase,ALT)、谷草转氨酶(glutamic oxaloacetic transaminase,AST)、血清总胆红素(total bilirubin,TBIL)、凝血酶原时间(prothrombin time,PT)、血浆活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、世界急诊外科学会(World Society of Emergency Surgery,WSES)肝脏外伤分级、美国创伤外科协会(American Association for the Surgery of Trauma,AAST)肝脏外伤分级等观察指标,选择合适的治疗方式,并将患儿分为保守治疗组及手术治疗组。观察指标包括HB、ALT、AST、TBIL、PT、APTT、AAST及WSES分级、住院时长、治愈率、并发症。结果150例中,保守治疗组131例、手术治疗组19例(14例行肝切除手术,5例行肝修补手术)。除1例因严重失血性休克死亡外,其余149例均治愈。AAST分级:手术治疗组AAST-Ⅲ级2例、AAST-Ⅳ级15例、AAST-Ⅴ级2例,保守治疗组AAST-Ⅰ级10例、AAST-Ⅱ级32例、AAST-Ⅲ级81例、AAST-Ⅳ级8例。WSES分级:手术治疗组WSES-Ⅳ级19例,保守治疗组WSES-Ⅰ级42例、WSES-Ⅱ级81例、WSESⅢ级8例。保守治疗组治疗前、治疗后HB[(106.71±15.41)g/L比(116.17±12.76)g/L],AST[(544.12±225.05)U/L比(33.11±7.86)U/L],ALT[(513.23±207.58)U/L比(43.60±19.00)U/L],TBIL[(10.42±3.38)μmol/L比(8.24±2.75)μmol/L],PT[(14.24±1.15)s比(14.18±1.45)s],APTT[(36.05±4.05)s比(36.65±3.72)s];手术治疗组治疗前、治疗后HB[(93.33±15.42)g/L比(120.67±14.14)g/L],AST[(547.71±230.83)U/L比(30.34±6.21)U/L],ALT[(523.22±240.98)U/L比(31.57±15.90)U/L],TBIL[(10.53±3.65)μmol/L比(7.86±2.28)μmol/L],PT[(14.83±1.50)s比(14.80±1.83)s],APTT[(37.68±6.39)s比(37.04±2.94)s];两组治疗前、治疗后HB�Objective To summarize the experience in diagnosing and treating pediatric liver trauma and to explore treatment strategies for pediatric abdominal closed liver trauma.Methods A retrospective anal-ysis was conducted on the clinical data of 150 children with liver trauma treated at the Department of General Surgery,Hunan Children's Hospital,from January 2013 to December 2022.The study included 85 males and 65 females,aged 4.66±2.91 years.Treatment approaches were selected based on indicators such as hemoglobin(HB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),prothrom-bin time(PT),activated partial thromboplastin time(APTT),the World Society of Emergency Surgery(WS-ES)liver trauma grading,and the American Association for the Surgery of Trauma(AAST)liver trauma grad-ing.Patients were divided into a conservative treatment group and a surgical treatment group.Observation indi-cators include HB,ALT,AST,TBIL,PT,APTT,AAST,and WSES grading,length of hospital stay(d),cure rate,and complications.Results Among the 150 cases,131 were treated conservatively,and 19 underwent sur-gery(14 cases of liver resection and 5 cases of liver repair surgery).Except for one death due to severe hemor-rhagic shock,the remaining 149 cases were successfully treated.In the conservative treatment group,there were significant differences in HB[(106.71±15.41)us.(116.17±12.76)],AST[(544.12±225.05)us.(33.11±7.86)],ALT[(513.23±207.58)us.(43.60±19.00)],and TBIL[(10.42±3.38)vs.(8.24±2.75)]before and after treatment(P<0.05).In the surgical treatment group,there were significant differences in HB[(93.33±15.42)us.(120.67±14.14)],AST[(547.71±230.83)us.(30.34±6.21)],ALT[(523.22±240.98)vs.(31.57±15.90)],and TBIL[(10.53±3.65)vs.(7.86±2.28)]before and after treatment(P<0.05).However,there were no significant differences in PT or APTT before and after treatment in either group(P>0.05).Additionally,there were no statistically significant differences between the two groups in terms of these indicators before

关 键 词：肝脏外伤 外科手术 儿童 

分 类 号：R47[医药卫生—护理学]