严重交通事故造成外伤性肝破裂诊治分析

Diagnostic and Therapeutic Analysis of Traumatic Liver Rupture by Serious Traffic Accidents

目的探讨严重交通事故造成外伤性肝破裂的诊断及治疗方法。方法回顾性分析45倒严重交通事故造成外伤性肝破裂患者的诊断、治疗方案及治疗效果等临床资料。结果全组成功治愈39例，占86．67％，其中保守治疗4例，手术治疗41例。根据病情轻重采取清创、缝合、修补、填塞压迫、局部缝扎、肝固有动脉结扎、修补术、引流胆道与引流腹腔等手术方式进行选择性治疗。肝外伤的手术后并发症有原发性与继发性大出血、胆汁瘘、胆道出血、腹腔内感染、应激性溃疡性出血、肝脓肿、膈下脓肿等。术中与术后因大出血、多器官功能衰竭、复合伤及严重感染死亡6例，病死率13．33％。结论准确的诊断及伤情评估，术前积极抗休克治疗，按不同创伤程度采用不同手术方式，同时积及治疗其它复合伤是降低死亡率的关键。

Objective To evaluate the diagnosis and treatment of traumatic liver rupture by serious traffic accidents. Method 45 cases with traumatic liver rupture were collected and the clinical materials of diagnosis, treatment and surgical styles were retrospectively analyzed. Result Through the treatments, 39 cases （86.67%） were fully recovered. 4 cases in which conservative treatment, 41 cases were operated in different procedures according to the severity of the trauma, more than 10 modalities such as dedridement, suturing, repairment, packing and pressing hemostasis, resection of traumatic parecchyma, hepatic artery ligation, vessel ligation with suturing in section, abdominal drainage andbilliary drainage etc were used. Postopera- tive complications of liver trauma are primary and secondary bleeding, biliary fistula, biliary hemorrhage, intra-abdominal infection, stress ulcer bleeding, liver abscess, subphrenic abscess. Because of intraoperative and postoperative bleeding, multiple organ failure, complex injuries to serious infections and 6 died, the mortality was 13.33%. Conclusion The accurate diagnosis and assessment of injury, preoperative active anti-shock therapy, It is the key to reduce mortality by treatmenting patients with different surgical trauma according to severity of injury.