闭合性肝外伤的非手术治疗决策(附105例报道)

Blunt liver trauma non-surgical treatment decision-making(105 cases reported)

目的:探讨闭合性肝外伤非手术治疗的选择。方法:回顾性分析15年来两所医院急诊收治的闭合性肝外伤患者的临床资料,结合近年国内外相关文献,从流行病学角度分析国内在不同时期闭合性肝外伤非手术治疗的选择、影响因素、结果的异同及变化。结果:国内闭合性肝外伤非手术治疗比例近8年明显升高,成功率有所下降,CT检查应用还不充分,治疗方案选择观念较陈旧。结论:非手术治疗是闭合性肝外伤治疗的重要手段,血流动力学稳定或经复苏稳定的患者均可列为候选对象;应适当扩大CT检查指征;观念更新很有必要。

Objeclive： To explore the choice which progress and current status of non-opera- tive management strategy for blunt hepatic trauma. Methods： The clinical data of patients with blunt hepatic trauma admitted to two the hospital during the past 15 years were retrospectively analyzed, combined domestic and foreign literature in recent years, from the epidemiological point of view of China at different times on the liver blunt trauma indication of the nonoperative management options, factors affecting the results of the similarities and differences and changes. Results： Closed do- mestic nonoperative management of liver injury rate increased significantly in recent 8 years, the success rate had dropped, and the fewer CT scanning was carried out in the patients with stable hemodynamics treatment options than the old concept. Conclusion： Non-operative management is becoming one of the most important strategies in the treatment of blunt hepatic trauma nowa- days. Non-operative management is widely acknowledged as the first choice for blunt hepatic trau-ma,especially for those with stable hemodynamics or hemodynamic stability in patients with stable recovery. This new trend should be more emphasized in China. Besides, CT scanning as a diagnostic tool should be carried out as frequently as possible in those patients with stable hemodynamics.