严重肝损伤的治疗与预后

Treatment and prognosis of severe liver injury

目的 探讨严重肝损伤的手术治疗及预后。方法 采用清创缝合止血 15例 ,带蒂大网膜、明胶海绵填塞缝合 2 9例 ,清创性肝切除 8例 ,纱布填塞 2例 ,结扎肝动脉 9例。结果 手术治愈33例 (6 1.1% ) ,死亡 2 1例 (38.9% )。术后胆瘘 2例 ,膈下感染 1例 ,继发性肝出血 1例 ,消化道出血1例 ,肾功能竭衰 1例 ,MOF1例。结论 严重肝破裂手术成功的关键是止血 ,死亡原因除与肝损伤出血有关外 。

Objective To evaluate the surgical treatment and prognosis of severe liver injury.Methods Debriding suture was performed on 15 cases of severe liver trauma. Twenty nine cases underwent packing suture of pedicle greater omentum and absorbable gelatin sponge. Debridement hepatectomy was performed on 8 cases. Two cases received Gauze tamponade. Hepatic artery was ligated in 9 cases.Results Thirty three ( 61.1% ) patients were cured and 21 died ( 38.9% ). Postoperative biliary fiistula occurred in 2 cases, subphrenic infection in one, secondary bleeding of liver in one, gastroinestinal bleeding in one, kidney failure in one and MOF in one.Conclusions The focus of the surgical treament to severe liver injury is hemostasis. Death is not only related with the bleeding of liver injury, but also with the severe degree of the compound injury.