严重肝外伤45例的治疗

Experience in treatment of 45 severe hepatic trauma patients

目的总结严重肝外伤的治疗经验。方法回顾性分析1995年1月～2005年12月45例严重肝外伤病例行外科治疗的临床资料，包括损伤程度、手术方式、治疗效果及手术并发症。结果肝外伤Ⅲ级24例，Ⅳ级16例，Ⅴ级5例。行肝缝合修补术21例，大网膜填塞缝合4例，肝血肿清除3例，清创性肝切除14例，规则性肝切除3例。治愈38例，死亡7例，其中术中出血死亡1例，术后再出血死亡2例，术后多器官功能衰竭死亡4例。术后发生并发症17例（37．8％），并发多器官功能衰竭4例，术后再出血3例，胆漏3例，膈下脓肿3例。结论手术是治疗严重肝外伤的主要方法。术中彻底止血，充分引流，预防多发性器官功能衰竭（MOF），可降低严重肝外伤术后并发症和死亡率。

Objective To summarize the experience of surgical treatment on severe hepatic trauma. Methods From January 1995 to December 2005, the clinical data of 45 patients with severe hepatic trauma treated with operation were summarized retrospectively, including injury degree, operation type, effectiveness and operative complications. Results There were 24 cases in grade Ⅲ, 16 cases in grade Ⅳ, 5 cases in grade Ⅴ. 38 cases were cured and 7 cases died. 4 cases died of multiple organ function failure and 3 cases died of hemorrhage. The overall mortality was 15.6%. Operative complications occurred in 37.8% of the patients included 4 cases of multiple organ function failure, 3 cases of hemorrhage, 3 cases of subphrenic infection, 3 cases of bile leakage. Conclusion Operation is a major method on severe hepatic trauma. It is necessary to take some measures to reduce complications and mortality including decisive suture, complete drainage and prevention of multiple organ function failure.