外伤性肝破裂的急诊诊断与处理

Emergency Diagnosis and Treatment for Hepatic Injury

目的 :探讨外伤性肝破裂的临床特点及诊治经验。方法 :回顾分析 95例外伤性肝破裂的伤因、伤型、伤情及合并伤情况 ,肝破裂与合并伤在诊治上的关系 ,救治方法和疗效。结果 :交通事故占 4 3.2 % (41/ 95 ) ;单一肝破裂仅 9.4 % (9/ 95 ) ,有合并伤的肝破裂 90 .6 % (86 / 95 ) ;合并腹外伤均妥善施行了手术或非手术治疗 ,肝破裂非手术治疗 5 .3% (6 / 95 ) ,手术治疗 94 .7% (89/ 95 ) ,合并腹内伤术中漏诊漏治率 8.2 % (5 / 6 1) ;全组治愈率 86 .3% (82 / 95 ) ,死亡率 13.7% (13/ 95 )。结论 :交通事故是肝破裂的最常见致伤因素 ,肝破裂大部分有合并伤 ,抢救时一定要妥善处理好肝破裂与合并伤在诊治上的先后、主次关系 ;手术治疗仍然是肝破裂最常用的方法 ,合并近肝静脉损伤和多发性合并伤的肝破裂的处理仍然是当今的难题 ,常温下全肝血流阻断修补近肝静脉损伤是一种较简捷可行的方法 ,有推广应用的价值。

Objective: To summarize the experiences gained in the specialties and emergency treatment of hepatic injury. Methods: To analyse 95 patients, injury cause, location, type, severity and associated injuries, and the problem of to which should be treated priority and the consequence of the resolution thus made. Results: Traffic accidents account for 43.2%(41/95), hepatic injuries accomplished with associated injuries account for 90.6%(86/95). All extra - celiac associated injuries were treated by operation or non-operation respectively, 94.7%(88/95) hepatic injuries were treated with operation, only 5.3%(6/95) were treated with non-operation, misdiagnosis rate were 8.2%(5/61) for intra - celiac associated injuries during operation. The cure rate of this group was 86.3%(82/95), and the death rate was 13.7%(13/95). Conclusions: Traffic accidents were the main causes, hepatic injuries accomplished by associated injuries account for the main part. It was important to conduct the differentiation of which one of them should be handled appropriately. Operation was still the widely used method. The treatment of hepatic injuries accomplished with juxta - hepatic vein injury and multiple injuries were still the difficult problems to tackle. The technique of hepatic blood flow totally blockaded under normal temperature was worthy of recommendation for clinical application.