肝脏损伤并发腹腔感染的防治

Prevention and treatment of intra-abdominal infection in liver trauma

目的探讨肝脏损伤并发腹腔感染的防治方法。方法回顾性分析2006年1月-2015年12月314例肝脏损伤患者的临床资料,男性221例,女性93例;年龄15-76岁,平均38岁。其中129例行非手术治疗,185例行手术治疗。结果 54例出现腹腔感染,均发生在手术组,感染率为29.2%。185例手术治疗患者中单纯性肝损伤73例[美国创伤外科学会（AAST）分级Ⅰ-Ⅱ级5例,发生腹腔感染0例;Ⅲ-Ⅴ级以上68例,发生腹腔感染14例],合并腹部其他脏器损伤或腹部外脏器损伤112例（AASTⅠ-Ⅱ级肝损伤45例,发生腹腔感染7例;Ⅲ-Ⅴ级肝损伤67例,发生腹腔感染33例）。54例腹腔感染中,49例治愈,治愈率为90.7%。结论严重肝脏损伤或合并腹部其他脏器损伤较易并发腹腔感染,根据肝脏损伤级别采取合理术式、保证充分引流、重视综合预防治疗措施可有效减少感染发生率和死亡率。

Objective To explore the measures for prevention and treatment of intra-abdominal infection in liver trauma. Methods The clinical data of 314 patients with liver trauma between Jan. 2006 and Dec. 2015 was analyzed. There were 221 males and 93 females,with age ranging from 15 to 76 years（ average,38 years）. Totally129 cases received non-operative treatment,and 185 cases received operative treatment. Results Fifty-four cases occurred peritoneal infection,all of whom were from the operation group,with the infection rate of 29. 2%. Of the185 cases in the operation group,there were 73 cases of isolated hepatic injury（ according to American Association for the Surgery of Trauma,68 cases of grade Ⅲ to grade Ⅴ with 14 cases developing peritoneal infection,and 5 cases of grade Ⅰ-Ⅱ without peritoneal infection）. A total of 112 cases were associated with other organ injuries（ 33 out of 67 cases of grade Ⅲ to grade Ⅴ developed peritoneal infection,and 7 cases of 45 cases of gradeⅠ-Ⅱ developed peritoneal infection. Of 54 patients with peritoneal infections,49 cases were cured（ 90. 7%）. Conclusion The incidence of intra-abdominal infection is high in the patients with severe hepatic injury or associated with multi-organ injury in the abdomen. Reasonable surgical procedures based on classification of liver trauma,adequate drainage and combined application of preventive techniques can effectively decrease the incidence and mortality of intra-abdominal infections in liver trauma.