83例严重肝脏创伤综合诊治分析

Analysis of comprehensive treatment in 83 cases of severe hepatic trauma

目的 探讨严重肝伤的综合诊治策略。方法 回顾分析重庆市第十三人民医院普通外科2005年9月到2015年9月83例严重肝脏创伤临床资料。按AAST-OIS分级,其中Ⅲ级39例（47.0%）,Ⅳ级34例（41.0%）,Ⅴ级10例（12.0%）。ISS评分：8~16分34例,17~52分46例。根据患者肝伤分级选用不同治疗方法,其中手术79例,非手术选用肝动脉栓塞4例,肝切除手术的膈下感染发生率低于修补和填塞（P〈0.05）。结果 治愈77例（92.8%）,死亡6例（7.2%）。术后并发症：术后出血4例,膈下感染9例,胆漏4例。结论 正确的诊治策略可以降低病死率和并发症发生率,肝切除术是治疗Ⅳ、Ⅴ级肝伤的重要手段,肝动脉断血术是治疗动脉性出血肝伤的有益补充。

Objective To discuss the strategy of comprehensive treatment on patients with severe hepatic injury. Methods A retrospective study of 83 patients with severe hepatic trauma treated in department of General Surgery, the Thirteenth People＇s Hospital of Chongqing City during Sept. 2005 to Sept. 2015 was collected. According to AAST-OIS, 39 （47.0%） patients were grade Ⅲ ,34（41.0%） were grade Ⅳ ,and 10（12.0%） were grade Ⅴ. According to ISS score,37 cases were 8-16,46 cases were 17-52. According to the different therapeutic methods,4 cases underwent hepatic angioembolization （HAE）,79 cases were treated by oper- ation. Results The cure rate of these study was 92.8%（77/83） ,and the mortality rate was 7. 2% （6/83）. Postoperative complica- tions were as following.4 cases with postoperative bleeding, 9 cases with subphrenic infection, 4 cases with bile leakage. Liver resec- tion had lower incidence rate of subphrenic infection than repairing and packing operations（P〈0.05）. Conclusion Right strategy of diagnosis and treatment results in a low mortality and morbidity rate. Liver resection is. an important mean of treating hepatic inju- ry,especially treating grade Ⅳ and Ⅴ hepatic injury. Hepatic artery ligation is beneficial to cease arterial bleeding of the liver injury.