外伤性肝破裂的诊断和救治  

The diagnosis and emergency treatment of traumatic hepatic rupture

作　　者：陈小春[1] 张桂英[1] 帅健[1] 

机构地区：[1]深圳市人民医院,518020

出　　处：《基层医学论坛》2004年第1期6-7,共2页The Medical Forum

摘　　要：目的总结外伤性肝破裂的诊断、抢救治疗的经验和教训。方法分析我院收治的120例外伤性肝破裂。结果本组中,车祸伤54例,刀刺伤28例,坠摔伤20例,其它18例。单纯肝破裂61例,合并其它脏器损伤者59例。腹腔穿刺、B 超和 CT 检查的诊断阳性率分别为92.3%、93.8%和93.6%。入院时休克108例。术中发现腹腔内积血300～3500ml,平均1350ml。肝修补75例,肝部分切除33例,保守治疗12例。全组治愈率93.3%(112/120)。结论早期诊断是及时救治外伤性肝破裂的首要环节。出血性休克是外伤性肝破裂致死的主要原因,抢救的重点在于纠正出血性休克。严重肝损伤应当机立断进行手术治疗,根据伤情选择单纯肝修补、肝修补加明胶海绵或大网膜填塞和肝脏部分切除,止血不满意还需加做选择性肝动脉结扎术。Objective To summarize the experience in the diagnosis and emergency treatment of trau- matic hepatic rupture.Methods Clinical pathological data of 120 patiens with traumatic hepatic rupture were studied retrospectively.Results In the group,there were 54 traffic accident wound,and 28 knife thorn wound ,and 20 downfallen wound ,and 18 others.61 cases had Simple hepatic rupture,59 cases were combined with injury of the other internal organs.The rate of accuracy diagnosis was 92.3%,93.8% and 93.6% in the diag- nostic peritoneal punctures,abdominal ultrasonography and CT respectively.When being hospitalized,108 cas- es were in shock.,We discovered abdominal cavity of patiens where amassed blood 300 ~3500 ml,average 1350 ml in operation.75 eases had been performed repair of liver,33 cases part resection of liver,and 12 cases conservative treatment.The total cure rate was 93.3%(112/120).Conclusion Early diagnosis is chief link that cure traumatic hepatic rupture.Hemorrhagic shock after hepatic trauma is cardinal lethal reason.The focal point of rescue is treatment of hemorrhagic shock..Serious liver injury should carry out operation treat- ment immediately.According to the condition of injury,repairing hepatic rupture purely,filling gelatin sponge or greater omentum in it simultaneously,or reseeting part of liver is regular.Dissatisfactory hemostasis need to add selectivity ligation of hepatic artery.

关 键 词：外伤性肝破裂 诊断 救治 术后并发症 肝部分切除 

分 类 号：R657.3[医药卫生—外科学]