肝外伤118例外科处理

SURGICAL TREATMENT OF HEPATIC TRAUMA (118 CASES REPORT).

目的 探讨提高肝外伤救治成功率的有效途径。方法 对 1990年 1月～ 2 0 0 0年 1月 10年间收治的 118例肝外伤病例进行分析。结果 手术治疗 80例 ,保守治疗 38例 ,与肝外伤相关并发症发生率为 16 .1% (19/ 118) ,病死率为 5 .9% (7/118)。结论 B超、CT等现代影像学检查手段提高了肝外伤的诊断和监测水平 ,更多的肝外伤患者可采用非手术治疗。对血液动力学持续不稳定的患者 ,积极手术是治疗成功的关键。肝门阻断对严重肝损伤的彻底清创、严密止血至关重要。医用生物蛋白胶的使用可有效制止肝创面渗血。肝静脉、肝后下腔静脉损伤时 ,采用改良全肝血流阻断是一有效措施。

Objective To study the effective method for the treatment of hepatic injuries.Methods 118 cases of hepatic injuries who were hospitalized to our department from January 1990 to January 2000 were analyzed.Results 80 cases underwent operative surgery,38 cases did conservative treatment.The morbidity related to hepatic injuries was 16.1% (19/118),and the mortality was 5.9% (7/118).Conclusion The application of modern diagnostic techniques such as abdominal ultrasonography and computed tomography have improved the diagnosing and monitoring level of liver injuries,more patients can be benefited from nonoperative treatment.To persistent hemodynamic unstable patients,active surgical procedure plays a key role in successful treatment.Portal triad occlusion is a very important procedure to thorough debridement and delicate hemostasis.The spraying of fibrin glue can effectively stop oozing from raw liver surfaces.The injured hepatic vein or retrohepatic IVC can be repaired successfully by means of modified total hepatic circulation occlusion.