不规则肝切除术联合静脉修补治疗近肝静脉损伤11例

Treatment of liver trauma combined with juxtahepatic venous injury by irregular hepatectomy and vein repair： a report of 11 patients

目的探讨肝外伤伴近肝静脉损伤的救治方法和术后死亡的相关因素。方法回顾性分析2001年1月-2007年12月共救治该类患者11例的临床资料。本组男8例，女3例；年龄22-65岁，平均33．7岁。致伤原因：交通伤7例，坠落伤3例，挤压伤1例。其中9例合并腹部其他脏器损伤，7例合并1处以上骨折。所有患者入院均有休克表现。结果全组无术中死亡，术后死亡3例。术后并发症包括出血6例，严重感染2例，肝功能衰竭3例，急性。肾功能衰竭2例，胆漏4例，腹腔脓肿4例，切口感染6例。术后随访6例，失访2例，随访时间3～79个月，1例患者术后21个月死于消化道出血，其余均生存。结论术中低血压是导致肝外伤伴近肝静脉损伤患者术后死亡的主要影响因素。不规则肝切除术联合血管修补可应用于抢救肝外伤伴近肝静脉损伤。

Objective To explore the management strategy for liver trauma combined with juxtahepatic venous injury and discuss relating factors leading to postoperative deaths. Methods The clinical data of 11 patients with juxtahepatic venous injury were retrospectively analyzed in aspects of preference of irregular hepatectomy and vein repair. There were 8 males and 3 females, at age range of 22-65 years （ mean 33.7 years）. Injury causes included traffic injury in 7 patients, fall-from-height injury in 3 and crush injury in 1. Of all, 9 patients were combined with other abdominal organ injury and 7 with over one part fractures. All patients showed symptom of shock on admission. Results No patient died during operation but 3 died after operation. The complications included bleeding in 6 patients, severe infection in 2, liver function failure in 3, acute renal function failure in 2, bile-leakage in 4, abdominal abscess in 4 and incision infection in 6. Conclusion Low blood pressure in the operation is the main cause for death. It is safe and effective to treat liver trauma combined with juxtahepatic venous injury with irregular hepatectomy and vein repair.