肝损伤外科治疗的分级处理(附84例报告)

SURGERY MANAGEMENT OF DIFFERENT LIVER INJURY(84 CASES REPORT)

目的 探讨肝损伤外科治疗的分级处理方法。方法 总结近年来 84例肝损伤治疗情况。其中 , 级 12例 , 级2 6例 , 级 32例 , 级 6例 , 级 8例。非手术治疗 18例 (占总数的 2 2 .6 % ) ;手术治疗 6 5例 ,单纯肝组织缝补 42例 ,不规则性、清创性肝切除 2 1例 ,碘仿纱条填塞 2例。结果 临床痊愈 75例 ,无手术并发症发生。死亡 7例 ,总病死率 8.33% ,分级病死率 : ～ 级 0 % , 级 6 .2 5 % (2 /32 ) , 级 0 % , 级 6 2 .5 % (5 /8)。结论 肝损伤应实行分级的外科限时处理 , 级以下损伤可适当保守治疗 , 级或其以上损伤应强化抗休克措施 ,依据损伤类型进行相应的手术治疗 ,以彻底清创止血 ,合理引流 ,防治并发症。

Objective To explore surgical management for different hepatic injury.Methods The data of 84 cases with hepatic injury in our hospital were summarized.Among these,Grade Ⅰ were found in 12 cases,Grade Ⅱ in 26,Grade Ⅲ in 32,Grade Ⅳ in 6,and grade Ⅴ in 8.Non_operation therapy were performed in 18 cases,operation in 65,merely liver tissue mended in 42,non_regular and debrided hepatectomy in 21,iodoform yarn strip packed in 2.Results 75 cases recovered clinically without complications.7 cases died(8.33%).The mortality in grade Ⅰ～Ⅱ was 0%,Grade Ⅲ 6.25%(3/32),Grade Ⅳ 0%,and Grade Ⅴ 62.5%(5/8).Conclusion Graded surgical management in limited time should be performed in hepatic injury.Injury under Grade Ⅲ should be appropriately performed conservative therapy,antishock management should be reinforced in injury under Grade Ⅲ,operation should be carried out according to the type of injury,to keep through debridement and stop bleeding,reasonable drainage,and prevent complication.