肝外伤的诊治体会

Diagnosis and Treatment of Hepatic Trauma

目的探讨肝外伤临床治疗的处理方法。方法总结75例肝外伤的治疗,其中肝外伤Ⅰ-Ⅱ级19例,Ⅲ级32例,Ⅳ级22例,Ⅴ级2例,合并器官损伤47例,手术61例,保守治疗14例,保守治疗无好转手术1例,清创性肝切除3例。结果手术61例全部成功,术后死亡2例,其中1例死于胸部并发症,1例为肝硬化患者,发生胆瘘5例,行保守治疗治愈4例,二次手术1例。结论肝外伤患者Ⅰ-Ⅲ级者的以保守治疗为主,手术治疗以清创缝合修补及纱布填塞为主,必要时可行清创性肝切除,尽量避免规则性肝切除。

Objective To evalute the management methods of clinical treatment on hepatic trauma. Methods Among 75 patients with hepatic trauma there were 19 cases in gradeⅠto grade Ⅱ ,32 cases in grade Ⅲ ,22cases in grade Ⅳ ,2 cases in grade Ⅴ ,47 cases were complicat-d with other organ trauma. 61 cases were operated, 14 cases conservative treatment, 1 case was operated because conservative treatment was not good, and debridement was performed on 3. Results Total 61 cases obtained successful surgery,2 cases died,among them 1 case died for chest complications, 1 case died for cirrhosis,5 cases were biliary fistula, among them 4 cases were cured by conservative treatment,1 case were operated second time. Conclusion Patients with liver trauma Ⅰ-Ⅲ grade mainly to conservative treatment, surgery for debridement to suture repair and gauze packing. When necessary, feasible debridement of the liver resection, to avoid the clear liver resection.