严重肝损伤的手术方式分析

Analysis of operation procedures for severe liver injury

目的探讨严重肝损伤的手术治疗经验。方法回顾性分析2002年10月至2015年4月收治的52例严重肝损伤患者资料。按美国创伤外科学会的肝损伤分级标准，结合影像学检查及术中所见将患者分级为：Ⅲ级19例，Ⅳ级27例，Ⅴ级6例。52例均行手术治疗，单纯缝合4例；清创缝合大网膜填塞16例；清创性肝切除24例；肝段切除2例；右半肝切除1例；肝周纱布填塞5例。结果本组52例患者中治愈48例，死亡4例。治愈率92．3％（48／52），病死率7．7％（4／52），1例死于门静脉右支破裂大出血，3例死于多器官功能衰竭。28例出现一种或多种术后并发症：术后出血6例，胆漏6例，肝脓肿5例，胸腔积液6例，切口感染3例，下肢深静脉血栓2例。结论CT检查能明确肝损伤的类型和程度。根据肝损伤分级确定非手术治疗或手术治疗：Ⅰ-Ⅱ级肝损伤可采取非手术治疗．Ⅲ～Ⅴ级肝损伤血流动力学不稳定或合并腹内其他脏器损伤应积极手术处理。

Objective To evaluate surgical treatment of severe liver injury. Methods Retrospective analysis on 52 patients with severe liver injury from October 2002 to April 2015 was made in accordance with liver damage by the American Institute of Traumatic Surgery （AAST）, incorporated with imaging examinations and intraoperative findings. There were 19 cases of grade ]]I, 27 of grade IV, 6 cases of grade V. All patients were treated by surgery： simple suture in 4 cases, omentum tamponade in 16 cases, debridement hepatectomy was performed on 24 cases, hepatic segment resection in 2 cases, right liver resection in 1 case, peripheral hepatic gauze packing in 5 cases. Results 48 cases were cured, 4 cases died. The cure rate was 92. 3% （48/52） , mortality was 7. 7% （4/52） , with one dying of right portal vein rupture and bleeding, 3 of multiple organ failure. 28 patients had one or more complications including postoperative hemorrhage in 3 cases, bile leakage in 6 cases, liver abscess in 5 cases, pleural effusion in 6, incision infection in 3 cases, and deep vein thrombosis of lower limbs in 2. Conclusions CT examination can identify type and degree of liver injury. Level Ⅴ liver injury are recommended to nonoperative treatment, while level Ⅲ～Ⅴ liver injury especially with hemodynamic instability or combined with other internal organs injury should be managed surgically.