闭合性肝外伤的非手术治疗

Nonoperative Management of Liver Injury in Children

目的 探讨小儿闭合性肝外伤非手术治疗（NOM）的可行性及适应证。方法 对采用NOM闭合性肝外伤患儿19例的临床资料进行分析。均有明确外伤史，创伤原因以车祸伤居首位，其中肝被膜下血肿11例（57．9％），肝实质裂伤8例（42．1％）。主要治疗措施是输血、止血，密切观察血流动力学指标。结果 非手术治愈17例（89．5％），中转手术2例（10．5％）。随访10个月～2年，全部患儿恢复良好。结论 由于小儿具有特殊的解剖及生理特点，大多数闭合性肝外伤采用NOM可获得满意效果。密切观察生命体征、及时的影像学检查及注意合并伤的处理是NOM成功的关键。

Objective To study the feasibility and indication of liver injury in children treated nonoperatively. Methods Ninteen cases with liver injury who tmderwent nonoperative management（NOM） were analyzed retrospectively. Patients with obvious trauma were reviewed. The main cause of trauma was due to traffic accident. Eleven cases（ 57.9 % ） had subcapsular hernatoma and 8 cases（42.1% ）had intrapararenchymatous hematoma. The treatment procedure included blood transfusion, hemostasis and monitoring the hemodynamic pa- rarneters. Results Seventeen cases（89.5% ）were cured nonoperatively;2 cases tmderwent the operation later. Followed up for 10 - 24 months,patients were well recovered. Conclusions Most of cases with liver injury in children can be cured by NOM due to the physicalogical and anatomic features of children. During treatment, it is very important for the doctors to observe the vital signs closely, and manage the combined injuries effectively and take regular imaging measurement.