闭合性肝破裂的选择性非手术治疗

Selective nonoperative management of blunt liver laceration.

目的 探讨闭合性肝脏破裂非手术治疗的选择标准和处理方法。方法 对闭合性肝破裂患者依据以下指征选择施行非手术治疗 :①血循环动力学平稳 (心率≤ 12 0次 /分 ,收缩压≥ 90mmHg ,所需输液量≤ 30ml/kg) ;②无需手术治疗的腹腔内脏损伤。对其伤因、损伤程度、临床表现、选择指征、治疗方法和治疗效果及并发症等进行分析。结果 4 1例闭合性肝破裂患者施行了非手术治疗。肝损伤Ⅰ、Ⅱ级者占 97.6 %。成功率为 10 0 %。平均住院日为 12天 ,出院后随访 6～ 39个月 ,除 1例伤后 2 7天发现肝脓肿并经皮肝穿刺引流治愈外 ,余未发现有关并发症。结论 选择合适的闭合性肝破裂患者施行非手术治疗是安全。

Objective To evaluate the indication and method for nonoperative management of traumatic liver laceration.Methods The patient's hemodynamic stability (pulse≤120 beats/min, systolic blood pressure ≥90 mmHg, after initial fluid resuscitation ≤30 ml/kg) and no concomitant intraabdominal injuries requiring operation were set up as the selection criteria of patients for nonoperative management. The clinical findings and treating results were analyzed.Results Fourty one patients were treated successfully with nonoperative management. 97.6% liver laceration were graded as Ⅰ and Ⅱ. There were no delayed laparotomies or deaths. Hepatic abscess occurred in one patient with grade Ⅲ liver laceration and was successfully drained percutaneously.Conclusion Nonoperative management of blunt liver laceration is a safe and useful alternative in the selected patients.