CT分级指导下肝外伤处理体会

Management Strategy of Hepatic Trauma with the Guidance of CT

目的探讨CT指导下外伤性肝破裂的诊断、分级及相应治疗方案。方法回顾性分析我院1998年8月-2008年8月收治的40例肝外伤患者的病例资料,其中闭合性肝外伤35例（87.5%）,开放性肝外伤5例（12.5%）。依据CT进行AAST诊断分级,其中Ⅰ级7例（17.5%）,Ⅱ级16例（40.0%）,Ⅲ级8例（20.0%）,Ⅳ级4例（10.0%）,Ⅴ级3例（7.5%）,Ⅵ级2例（5.0%）。对Ⅰ-Ⅲ级患者行保守治疗,Ⅳ-Ⅵ级患者急诊行肝脏缝扎或肝切除术。结果2例Ⅲ级患者在保守治疗期间因血流动力学监测不稳定而转手术治疗,余均按原方案治疗。40例中治愈36例（90.0%）,胆漏2例,经多次穿刺引流好转;2例Ⅵ级术后由于合并重度脑外伤、肝脓肿和肝功能衰竭死亡。结论外伤性肝破裂应及时诊断,制订合理的治疗方案,依据CT分级选择合理的治疗方案是肝外伤治疗的关键。

Objective To explore the diagnosis, classification, and treatment protocols of hepatic trauma under the guidance of CT. Methods The clinical data of patients with hepatic trauma admitted to our hospital during the latest 10 years were retrospectively analyzed. Among 40 patients with hepatic trauma, 35 patients were with close trauma, and 5 with open trauma. After CT score, 31 patients of stage Ⅰ to Ⅲ were dealt with conservative treatment, and 7 patients of Ⅳto Ⅵwere treated by surgical treatments. Results Among 40 patients, 36 healed without complication. 2 patients suffered from biliary fistula and were cured by puncture and drainage. 2 patients died of severe brain trauma, hepatic abscess, and hepatic failure. Conclusion It is the key point to deal with the hepatic trauma according to the AAST score under the guidance of CT.