肝脏损伤诊治进展

Progress of diagnosis and treatment for liver trauma

随着影像学诊断和治疗技术的进展,肝脏损伤的非手术治疗越来越多地被接受。但对于有致命性大出血的严重肝脏损伤,尤其伴有肝后静脉损伤时,多予手术治疗,且死亡率和并发症发生率高。按照肝脏损伤的级别合理采用综合手术治疗方法,将明显改善治疗效果,第一肝门阻断(Pringle法)下肝切除是一重要治疗手段。肝后静脉损伤的主要对策是全肝血流阻断或转流下肝切除或肝切开显露和修补肝后静脉;难以耐受此术式时,肝周填塞是明智的选择。

With advancement in imaging diagnosis and interventional therapy,more and more patients with liver trauma are treated nonoperatively. In those patients with severe hepatic injuries,however, especially associated with post-hepatic venous injury,operative treatment is frequently used, and it continues to be associated with high morbidity and mortality. ImprOvement of therapeutic efficacy can be obtained based on reasonable option of surgical procedures according to the classification of liver trauma during the operation. Hepatectomy, regular or irregular, under occlusion of the portal triad by Pringle maneuver is an important technique for treatment of severe liver trauma. To deal with post-hepatic venous injuries, sometimes, direct exposure and repair can be achieved via hemihepatectomy or hepatotomy under total hepatic vascular occlusion. Facing those patients who can＇t toleyate such procedure, perihepatic packing is a wise option.