肝损伤54例诊治分析

Diagnostic and treatmeat analysis of hepatic injury：reports of 54 ca ses

目的探讨肝损伤的诊断与治疗。方法笔者对1975年12月至1999年12月诊治的54例肝损伤病例进行临床回顾性分析。结果本组开放性损伤9例167%,闭合性肝损伤45例833%;按AAST标准对肝损伤进行分级,Ⅰ级12例222%、Ⅱ级28例519%、Ⅲ级9例167%、Ⅳ级3例56%、Ⅴ级2例37%、无Ⅵ级。非手术治疗11例、全部治愈204%;手术治疗43例,死亡5例、死亡率93%,均属AASTⅢV级严重肝损伤。结论和平时期肝损伤主要发生于工农业生产及交通事故;开放性肝损伤诊断较易,闭合性损伤在有严重合并伤时诊断较困难。肝损伤以手术治疗为主,对血液动力学稳定的轻度AAST分级ⅠⅡ、无腹腔合并伤的患者可在ICU及B超、CT严密监控下进行非手术治疗;肝损伤手术治疗原则是清创、止血、缝合、引流,根据损伤的不同程度可分别采用:①清创、止血、缝合术;②肝动脉结扎术;③肝叶切除术;④肝周纱布填塞术;⑤肝后下腔静脉修补术等不同手术方法,但无论采取何种手术术后均应在肝周放置多根橡皮管引流,以利及时引流渗血、胆汁、早期发现再出血并得到及时手术治理。

Objective：To research and discuss t he diagnosis and treatment of hepatic injury．Methods：５４cases of hepatic in－jury during the period of Dec ．１９７５to Dec．１９９９．We analysed ret rospectiv ely．Results：There were ９cases of open injury（１６．７），４５cases of closed injury，and by the g rad ing of AAST standard，there were １２cases ofⅠgrade（２２．２％），２８cases of Ⅱgrade（５１．９％），９ofⅢ（１６．７％），３ofⅣ（５．６％），２ofⅤ（３．７ ％）and none ofⅥ。Among them，All １１cases of non－opera tive treatment were c ured，４３cases got op erative treatment and ５died，the dea th rate was ９．３ ％．All the ５belonyed to AASTⅣ－Ⅴgrade hepatic injury．Conclusion：It is easi er to diagnose open hepatic injury，but difficult for closed noe with severe com bined injury．The hepatic injury patients should take operative treatment，but f or the slight ones，non－operative treatment can be taken and closed watching wi th ICU，B－ultraso nography and CT．The priaciple of operative treatment is to d ebride，heme stase，suture and drainage．The most important one is t o put many libber cathe ters around li ver to drainage after any operation i n order to dra inage the oozing blood，bile and to discove r earlierty the rebleeding as to giv e operation in time．