小儿肝脾损伤的非手术治疗——附44例临床分析

Nonoperative management of blunt hepatic and splenic injury in pediatric patients, analysis of 44 cases

目的探讨小儿肝脾损伤的诊断和非手术治疗方法。方法分析１９８８年１月～１９９８年１０月收治肝脾损伤患儿４４例。结果肝脏损伤２０例，腹腔穿刺阳性率９２．９％，肝包膜下血肿１２例（６０．０％），肝破裂、实质内血肿８例（４０．０％），平均输血量在２０ｍｌ／ｋｇ以下。所有肝外伤病例均保守成功。脾脏损伤２６例（２例伴有肝损伤），腹腔穿刺阳性率８４．２％，脾包膜下血肿６例（２３．１％），脾内部挫伤血肿１２例（４６．２％），非手术治疗组中输血量在１０～３０ｍｌ／ｋｇ以内，手术组术前平均输血量在２０～２５ｍｌ／ｋｇ以上。脾损伤保守成功２３例（８８．５％）。结论小儿肝脾损伤具有保守成功率高之特点。腹腔穿刺有助于诊断但不是手术指征，在保守治疗过程中需要密切观测患儿的生命体征、血色素、血球压积，以及在纠正休克前的总输血量，这些有助于及时判断是继续保守还是手术探查。

Objective To appraise the method for diagnosis and nonoperative management of blunt hepatic and splenic injuriey in pediatric patients.Methods By analyzing the data of 44 children with blunt liver and spleen injury who were admitted from January 1988 to October 1998. Results 20 children had injury of the liver, Possitive abdominal puncture was 92.9%, among these, 12(60%) had subcapsular hematoma, 8(40%) had intra parenchymatous hematoma. All these were treated conservatively, the mean volume of trasfusions was below 20ml/kg. 26 children had jnjury of the spleen (2 had both hepatic and splenic injuries), positive adbominal puncture was 84.2%, 6 children(23.1%) had subcasular hematoma, 12 children (46.2%) intrasplenic hematoma. In nonoperative group, the mean volume of transfusion was between 10 to 30ml/kg; that of operative group was 20 to 25 ml/kg. The successful rate of non opreative treatment was 88.5%. Conclusion Nonoperative management of hepatic and splenic injury in pediatric patient had a high rate of success. Adbominal puncture provides the clue to visceral hemorrhage, care should be taken to watch for the dynamic changes of blood pressure, heart rate, respiretory rate, heamoglobin and hematocrit which are beneficial for making decision of laparotomy or continuation of conservative management.