非手术治疗成人钝性肝损伤32例临床分析

NONOPERATIVE MANAGEMENT OF ADULT BLUNT HEPATIC INJURIES:REPORT OF 32 CASES

目的 探讨血液动力学稳定的成人钝性肝损伤非手术治疗的安全性和有效性。方法 回顾性分析 1989年 3月～ 1998年 6月间 3 2例成人钝性肝损伤非手术治疗的资料。结果 所有病人在入院时行急诊腹部 CT扫描。 CT损伤分级如下 : 级 5例( 15 .6% ) , ～ 级 2 5例 ( 78.1% ) , 级 2例 ( 6.3 % )。这些损伤部位位于右肝 2 5例 ,左肝 6例 ,中央型损伤 1例。全组 97% ( 3 1/3 2 )的病人非手术治疗成功。 3 2例病人中 18例在住院期间输血 ,这些病人平均输血 2 .8u。并发症包括 2例胆汁包裹性积聚和 1例肝下间隙积液伴感染 ,这 3例均经皮引流治疗成功。本组无死亡 ,无严重并发症 ,未遗漏腹腔内合并伤 ,无延迟出血发生。结论 成人钝性肝损伤的非手术治疗显然是血液动力学稳定和无其他剖腹术指征的病人的首选治疗方法 ,这种方法应用于经选择的病人是安全有效的。创伤后仅仅血腹的存在不再是剖腹探查的绝对指征。首次 CT随访的恰当时机似乎是伤后 7～ 15天。

Objective To evaluate the safety and effectiveness of nonoperative management of blunt hepatic injuries(BHI)in adult patients with stable hemodynamic . Methods 32 patients with BHI who under went onoperative management during March 1989 to June 1998 were reviewed. Results All patients underwent emergency abdominal CT scanning at admission.The CT scan grading was as follows:grade Ⅰ,5(15.6%);grade Ⅱ-Ⅲ,25(78.1%);grade Ⅳ,2(6.3%).25 patients were confined ti the hepatic right lobe,6 were located on the left,and 1 was in central location.97%(31 of 32)were successfully managed nonoperatively in this series.blood transfusions were given in 18 of 32 patients during the hospitalzation.The mean transfusion volumes were 2.8 units.Complications included bilomas in 2 cases and subhepatic infected accumulation of fluid in 1 cases..All the patients were successfully cured by percutaneous drainage.In this series there were no deaths ,no major complication,no intraabdominal injuries,and no delayed hemorrhage. Conclusions Nonoperative management of adult blunt hepatic injuries the first choice in patients with stable hemodynamic and with out indications for laparotomy.This approach applicable to select patients is safe and effective.The hemoperitoneum following trauma is no longer an absolute indication for laparotomy.The appropriate time for the first follow-up CT scans seems to be within 7～15 days after injury.