严重肝外伤术后并发症的防治

Prevention and Treatment for Postoperative Complications of Severe Hepatic Trauma

目的探讨创伤性肝破裂术后并发症发生的原因及治疗措施。方法回顾性分析50例严重肝外伤病例行手术治疗的临床资料,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26例,Ⅳ级18例,Ⅴ级6例。行肝缝合修补术21例,大网膜填塞缝合6例,肝血肿清除5例,清创性肝切除14例,规则性肝切除3例。术后发生并发症19例(38.7%),死亡7例(14.2%)。结论术中彻底止血、充分引流、预防多器官功能衰竭,可降低严重肝外伤术后并发症和死亡率。

Objective To explore the causes of postoperative complications in traumatic liver and treating measures. Methods 50 cases of severe hepatic trauma treated with operation admitted were retrospectively reviewed with regard to degree of trauma, operation methods, the curative effects and complications. Results In accordance with the traumatic grading system, 26 cases, 18 cases and 6 cases were defined as gradeⅢ, Ⅳand Ⅴ respectively. Different operation were performed as following： suture of laceration in 21 cases, suture and omentum packing in 6 cases, debridement of hematoma in 5 cases, debridemental hepatectomy in 14 cases, anatomical hepatectomy in 3 cases. Postoperative complications occurred in 19 cases（38.7%） There were 7 cases death（14.2%）. Conclusion There are effective methods to reduce complications and mortality including effective hemostasis, complete drainage, and prophylactic treatment of MOSF.