肝外伤后早期非计划性再手术的原因分析及预防

Causes and prevention of non-planned reoperation early after hepatic trauma

目的分析肝外伤后早期非计划再手术的原因，探讨有效的预防措施，以提高肝外伤的手术质量。方法对1995年1月-2008年12月间收治的12例肝外伤后早期非计划性再手术患者的临床资料进行分析。结果再手术的主要原因为：首次手术漏诊5例，肝创面的处理方法不当3例，术后感染2例，肝硬化引起创面大出血2例。本组治愈11例，再次手术后平均住院时间为18d。本组1例网失血性休克、DIC、MODS死亡。结论全面探奄、创面充分止血、通畅引流，术后支持治疗如护肝、促凝及抗感染等足防止肝外伤后非计划性再于术的有效措施。

Objective To analyze the major causes of reoperation early after hepatic trauma and explore effective preventive measures so as to make an improvement in operation quality for hepatic trauma. Methods The data of 12 patients with hepatic trauma undergone re-operation from January 1995 to December 2008 were analyzed retrospectively. Results The causes of reoperation were missed diagnosis in initial laprotomy in five patients, inappropriate surgical procedures in three, postoperative infection in two and hemorrhea induced by hepatic cirrhosis in two. Of all patients, 11 patients were cured, with overall cure rate of 91.7% （11/12） and average hospital stay of 18 days. One patient was died of hemorrhagic shock, disseminated intravascular coagulation and MODS, with overall mortality rate of 8.3% （1/12）. Conclusions Complete interventional exploration, sufficient haemostasis for hepatic wound surface and sufficient drainage in initial laparotomy as well as postoperative supportive treatments like liver protection, procoagulation and anti-infection are effective preventive measures to decrease the incidence of reoperation in patients with hepatic trauma.