外伤性肝破裂34例诊治分析

Diagnostic and therapeutic analysis of 34 cases with traumatic hepatic rupture

目的总结外伤性肝破裂的诊治经验。方法回顾分析34例外伤性肝破裂患者的诊断、治疗方案及术式等临床资料。结果保守治疗9例(2例中转手术),手术治疗的术式主要以缝合+大网膜或明胶海绵填塞(18例)和碎肝组织清除+缝合修补(5例)为主,经治疗后33例痊愈,1例死亡。结论Ⅱ级以上肝破裂应及时手术,小裂口做U形缝合,较大创口需结扎创缘胆道结构,清除碎肝组织,破碎严重者则行部分肝切除术,同时注意合并伤处理,术后应护肝、抗感染。

Objective To summarize the experiences on diagnosis and treatment for traumatic liver rupture. Methods 34 cases with traumatic liver rupture were collected and the clinical materials of diagnosis, treatment and surgical styles were retrospectively analyzed. Results 9 cases were conservatively treated （2 cases were transferred to surgical operation during the conservative treatment） . The other 25 cases were administered with surgical operation. Of the 25 cases, 18 cases were operated with suturing wound and plugging wound with gelatin sponge or colic omentum, 5 cases were operated with cleaning the broken liver tissue and suturing wound. Through the treatments, 33 cases were fully recovered and 1 cases died. Conclusion Liver rupture whose grade is over than Ⅱ grade should be administered with surgical operation in time. Little rapture can be U-shape sutured. Large wound should be treated with ligating structures of biliary tract on wound side and cleaning the broken liver tissue. Patients with heavy liver rapture should be treated with partial hepatectomy. In the meantime, the associated injuries must be payed much attention to. Liver protection and anti-infection should be taken after the operation.