肝外伤157例临床治疗分析

The treatment of liver trauma in 157 cases

目的 提高对不同类型肝外伤的诊断和治疗水平。方法 回顾性总结 1 990年 9月至 2 0 0 2年 1月我中心收治的 1 5 7例肝外伤患者 ,包括非手术治疗 3 2例 ,手术治疗 1 2 5例。结果 非手术治疗 3 2例 ,完全治愈 2 8例 ,4例死亡。手术治疗 1 2 5例 ,完全治愈 1 0 7例 ,死亡 1 8例 ,总治愈率 85 .9%(1 3 5 /1 5 7) ,病死率 1 4.1 %(2 2 /1 5 7) ,其中 9例死于多发性创伤合并多器官功能衰竭 (MOF) ,8例死于肝内大血管损伤引起的出血 ,5例死于术后并发症。结论 肝外伤病情危重 ,临床表现复杂 ,早期正确诊断、及时和合理的手术治疗是减少死亡率提高救治水平的关键 ,积极抗休克 ,实行重症监护和防治并发症等非常重要。血流动力学稳定的患者可行非手术治疗。

Objective To improve the diagnosis and treatment of liver trauma. Methods We retrospectively analyzed different therapeutic means on liver trauma in our hospital from September 1990 to January 2002 ,including 125 cases with operative treatment and 32 cases with nonoperative treatment. Results In nonoperative treatment group,28 cases were cured,4 cases died. In operative treatment group, 107 cases were cured, 18 cases died. Cure rate was 85.9%(135/157), mortality was14.1%(22/157).9 cases died on multiple organ function failure,8 cases died of major blood vessels rupture,5 cases died on postoperative complications. Conclusions The liver trauma are of very critical illness, it's important to make early dignosis, promt and proper surgical operation. Meanwhile, active antishock measures, postoperative complication prevention, critical care for the patients are also very important for a better prognosis. The liver trauma can be treated by nonoperation on the condition of intensive monitoring.