外伤性肝破裂693例统计分析

ANALYSIS OF 693 CASES ON TRAUMATIC RUPTURE OF THE LIVER

为了解近年来外伤性肝破裂的诊治情况，对1990年1月～1995年12月6年间我国部分省区的对所医院收治的外伤性肝破裂患者693例进行了统计分析。693例中男559例，女134例，男女之比为4．17：1，年龄1～77岁，平均39．3岁。闭合性伤占74．5％，交通事故伤占闭合伤的52．9％。伤后4小时内入院者占49．4％，入院时伴失血性休克者占61．9％。术中见上腹腔积血1000ml以上者占61．5％，损伤位于右肝者占70．0％，有合并伤者占19．8％，AAST分类Ⅱ级以上者占45．5％。手术方式以清创缝合及网膜填塞为主，占83．7％，49例行肝部分切除术。术后并发症发生率为22．2％，死亡率为87％。作者认为：进一步建立和健全急救体系、提高基层技术队伍素质及术中对肝外伤的正确处理是提高我国肝外伤救治成功率及降低死亡率的关键。

To comprehend the present situation in diagnosis and treatment of traumatic hepator-rhexis in this country, 693 patients with traumatic rupture of the liver in 31 hospitals where to be locatedin Sichuan,Zhejiang,Guizhou, Yunnan, Fujian,Heilongjiang,Guangxi and Hebei province in this countrywere collected through questionnaire and analysed. The data showed that male to female ratio was 4. 17to l,with an average age of 39. 3 years. Closed injury accounted for 74- 5% and 53. 9 percent of themwere injured in traffic accident. 47. 4% of the patients were admitted to the hospital within 4 hours ofterinjury. Hemorrhagic shock was present high up to 61.9%. During exploratory laparotomy,hematoperi-toneum was greater than 1000ml accounted for 61. 5%,injury to the right lobe of liver 70. 0%,and hepa-'torrexis associated with other organs and tissues injuries were 19. 8%. 45. 5% of the patients was inthird degree or more according to the AAST classification. All of the patients were treated by surgery,83' 7% percent of them with debridement and suture and omentum packing for hemostasis, 49 patientsundergone partial hepatectomy. The postoperative complication rate was 22. 2% and mortality was8. 7%. The authors consider that to perfect the emergency treatment system,enrich the knowlege andskill of the basic personnel so that the injured can be properly treated is crucial to improve the cure rateand reduce the mortality.