基层医院闭合性肝外伤的临床诊治经验与体会

目的总结基层医院在闭合性肝外伤的临床诊治方面的经验和体会。方法根据患者自身情况分别采用保守治疗、单纯性肝修补术、肝动脉结扎与清创缝合修补术相结合、大网膜填塞与清创缝合修补术、清创性肝叶切除术、纱垫填塞术等方法进行治疗,总结其经验和体会。结果所有患者中,治愈60例,愈合率为95.2%,死亡3例,死亡原因为:重型失血性休克2例,手术后合并感染MSOF 1例。治愈的60例患者中,出现并发症的有9例,并发症发生率为15%,发生膈下脓肿2例,肺部感染3例,切口感染2例,胆漏1例,粘连性肠梗阻1例,经过保守治疗后均治愈出院。结论尽快诊断,及时采取合理的治疗方案,加强术后的护理是提高闭合性肝外伤患者愈合率,降低并发症发生率和死亡率的关键。

Objective To summarize the basic-level hospitals experience in clinical diagnosis and treatment of closed liver trauma. Methods According to patients＇ condition with conservative treatment, simple repair liver and hepatic artery ligation combined with debridement suture repair, greater omentum tamping and debridement suture repair, dehridement sex liver resection, ShaDian tamping technique methods such as treatment, summarize the experience and understanding. Results All the patients, cured 60 cases, the healing rate was 95.2%, 3 cases died, the cause of death for： heavy uncontrolled hemorrhagic shock in 2 cases, amalgamative infection MSOF 1 cases after the operation. Cure of 60 cases of complications in 9 cases, the incidence of complications was 15%, under the diaphragm abscess occurred in 2 cases, pulmonary infection （3 cases）, incision infection in 2 cases, bile leakage in 1 case, adhesion sex intestinal obstruction in 1 case, after conservative treatment were cured after discharged from hospital. Conclusion Diagnosis as soon as possible, take timely and reasonable treatment, strengthening postoperative care is to improve the patients with closed hepatic trauma healing rate, reduce the incidence of complications and mortality.