严重肝外伤25例术后再出血原因分析

Analysis of 25 cases of rebleeding after surgicaltreatment of major hepatic trauma

目的探讨严重肝外伤术后再出血的原因。方法对1985年1月～2004年11月手术治疗的97例严重肝外伤,术后再出血25例的2次手术所见及保守治疗效果进行回顾性分析。结果按AAST对肝脏损伤的分级,Ⅲ级外伤12例,Ⅳ级外伤8例,Ⅴ级外伤5例,第1次术后累计出血量800～2700mL,平均1500mL。2次手术止血19例,死亡5例;保守治疗6例,死亡2例(其中失血性休克3例,复合伤、多脏器功能衰竭各3例,严重感染致ARDS1例)。结论严重肝外伤术后再出血的原因有多种,但最常见的是术中及术后处理方法不当。

[Objective] To investigate the causes of the rebleeding after the operation of major hepatic trauma. [Method] To analyse retrospectively what we have seen in the second operation and the outcome of the conservative treatment in the 25 cases rebleeding after the operation of 97cases severe liver injuries from January 1985 to November 2004. [Result] According to the AAST Gading of Liver Injuries, gradeH[ 12 cases, gradeⅣ8cases, grade V 5 cases, the accumulative total bleeding volume after first operation was 800-2 700 mL, average 1500 mL second operation were performed in 19 cases, 5 cases died; 6cases were undergone conservative treatment, 2 cases died （3 cases of hemorrhagic shock, 3 cases of combined wound and multiple organs failure, 1 cases of ARDS caused by severe infection）. [ Conclusion] There were several causes for the rebleeding after the operation of major hepatic trauma, but the most common causes we have seen were improper intraoperative and postoperative management.