儿童闭合性肝损伤治疗的改进

Improvement in Treatment of Blunt Liver Injury in Chilhood

目的 :探讨改进治疗方法对减少儿童闭合性肝损伤并发症、降低死亡率的作用。方法 :对我院 1983 6～ 1999 9间 95例儿童闭合性肝损伤资料分两时期进行对比分析。结果 :前期 ( 1983 6～ 1993 8)手术治疗 5 3例 ,并发症率为 3 3 9% ,死亡率为 13 2 %。近期 ( 1993 9～ 1999 9) 42例 ,选择性非手术治疗 2 0例 ,手术治病 2 2例 ,并发症发生率为 2 1 4% ,下降显著 (P <0 0 5 ) ,死亡率为 11 9% ,与前期相比差异无显著意义。结论 :选择性非手术治疗儿童肝损伤可减少并发症的发生 ,严重肝损伤是死亡的主要原因 ,加强术前复苏治疗 ,术中彻底止血可降低死亡率。

Objective:To evaluate the way of improving the treatment of blunt liver injury in lowering morbidity and mortality.Method:The data of 95 children substaining hepatic injury treated from June 1983 to September 1999 were analysised.Results:During the years from June 1983 to August 1993,53 children with liver trauma were operated treated with a morbidity rate of 33 9% and a mortality rate of 13 2%.In recent years from September 1993 to September 1999,42 children were managed.Among then,20 children were selected for nonoperative treatment while 22 children were operated on.The norbidity rate was 21 4% and significantly lower than that from the treatment in earlier years.Conclusions:The nonoperative treatment selectively used for liver injury in childhood could lower the in cidence of complications.Severe liver injury is the main cause for death.The prompt resuscitation before operation and complete hemostasis during operation could reduce the mortality.