Analysis on care outcome of patients with polytrauma and coma

Objective ： To make further improvement of outcome of patients with polytrauma and coma. Methods： The data of 3 361 patients （2 378 males and 983 females, aged from 5-95 years, 38. 2 years on average） with severe polytrauma and coma admitted to Chongqing Emergency Medical Center （Level I Trauma Center ）, Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. Results： The overall survival rate and mortality were 93.2%（3 133/3 361 ）and 6.8%（228/3 361 ）, respectively. The mortalities in patients with coma duration 〈 1 hour and combined with neural dysfunction and in patients with coma duration ≥ 1 hour and combined with or without neural dysfunction were signifieantly higher than that of those with coma duration 〈 1 hour but without neural dysfunction [39.5%（136/344）vs 3.0%（92/3 017）, P 〈0.01]. There existed significant differences in GCS, ISS, and revised trauma score （RTS） between the death group and the survival group （P 〈 0. 01 ）. RTS was in good correspondence with patient＇ s pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure （SBP）. The mortality in patients with SBP 〈90 nun Hg was significantiy higher than that of those with SBP ≥ 90 mm Hg [ 33. 3 % （68/204） vs5.1%（160/3 157）, P 〈0.01]. The mortality in polytranma patients combined with serious head injury （AIS≥3） was8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury （23.9%, 61.1% vs 27.3 %, 50.0 % ）. The mortality reached up to 61.9 % in patients complicated with severe head, chest and abdomen injuries simultaneously. Conclusions： It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe palytrauma and coma.     

严重复杂的胰腺创伤临床处理探讨

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.     

Polytrauma with thoracic and/or abdominal injuries： experience in 1 540 cases

Objective:To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries. Methods: The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively. Results: In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% (181/1206) and 79.9% (612/766) in patients with thoracic and abdominal injury (P<0.01), 5.2% (39/758) and 31.7% ( 142/448 ) in patients with blunt and penetrating chest trauma (P<0.01). and 72.4% (359/496) and 93.7 % (253/270) in patients with blunt and penetrating abdominal injuries (P<0.01), respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9% (75/950) and 3.6% (21/590), respectively (P<0.01). Most patients died from exsanguination. Conclusions: The first "golden hour" after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.     

重症胰腺炎病死原因分析:附144例

Objective To explore the main causes for death due to severe acute pancreatitis (SAP) to improve the level of diagnosis and treatment. Methods The clinical data of 1162 SAP cases treated in our hospital from June 1997 to May 2005 were retrospectively analyzed. Among which, 144patients (12. 39%) died, 82(7.06%)abandoned treatment and 936(80.55%)were cured. Results the APACHE Ⅱ scores and pancreas Balthazar CT scores of the death group were higher than that of the survival group. The percentage of single one organ dysfunction and multiple organ dysfunction syndrome (MODS) was significantly higher in the death group than in the survival group. The mortality rate of SAP without obvious inducing factors was significantly higher than that of SAP with inducing factors. Conclusion Integrated traditional and western non-surgical treatment is effective for SAP.The treatment for SAP without obvious inducing factors is a challenge. The mortality rate of SAP is primarily related to the pathological changes of pancreas and the patient's general condition. Early diagnosis and treatment is important to decrease mortality rate and maintaining the function of important organs is basic to ensure curative effect.     

严重复杂的胰腺创伤临床处理探讨

Objective To summarize the experience in diagnosis and management for severe and complicated pancreatic trauma. Methods The clinical data of 21 patients with severe pancreatic trauma treated in our hospital were retrospectively analyzed. Of the 21 with a mean age of 26 (9-53), 14were male and 7 female. The causes of trauma were blunt injuries in 13 and patent injuries in 8 of them. The injury grade distribution for these patients was grade Ⅲ in 8 cases, grade Ⅳ in 8, and grade V in 3. The main diagnostic modalities included amylase measurement, ultrasonography, CT,endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP) etc. All patients received surgical procedures. Roux-en-Y distal pancreatojejunostomy was performed in 10 patients, pancreatoduodenectomy in 3, modified duodenal diverticulization in 2, distal pancreatectomy in 3, tube installing in major duct and external drainage, and suture of pancreatic section in 2, and suture of two broken side respectively (delayed distal pancreatojejunostomy in the second time) in 1. Results Pancreatic injury was confirmed in 11 cases preoperatively and intraoperatively in the others. The early emergency operation was performed in 18 patients within 12hours, and delayed operation was done in 3 cases. Twenty patients were cured and 1 died after a procedure of pancreatoduodenectomy. The postoperative pancreatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusion The diagnosis of severe and complicated pancreatic trauma is difficultly yet, so the earlier exploratory laparotomy should be suggested. The individual surgical modality based on the grade should be adopted in the operation and the concept of "Damage Control Surgery" should be carried out in the procedure. Extended operation should be avoided.     

重症胰腺炎病死原因分析:附144例

Objective To explore the main causes for death due to severe acute pancreatitis (SAP) to improve the level of diagnosis and treatment. Methods The clinical data of 1162 SAP cases treated in our hospital from June 1997 to May 2005 were retrospectively analyzed. Among which, 144patients (12. 39%) died, 82(7.06%)abandoned treatment and 936(80.55%)were cured. Results the APACHE Ⅱ scores and pancreas Balthazar CT scores of the death group were higher than that of the survival group. The percentage of single one organ dysfunction and multiple organ dysfunction syndrome (MODS) was significantly higher in the death group than in the survival group. The mortality rate of SAP without obvious inducing factors was significantly higher than that of SAP with inducing factors. Conclusion Integrated traditional and western non-surgical treatment is effective for SAP.The treatment for SAP without obvious inducing factors is a challenge. The mortality rate of SAP is primarily related to the pathological changes of pancreas and the patient's general condition. Early diagnosis and treatment is important to decrease mortality rate and maintaining the function of important organs is basic to ensure curative effect.     

Application of damage control orthopedics in 41 patients with severe multiple injuries

Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males and 10 females, aged 18-71 years, mean： 36.4） with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005.
Results： As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% （5/41） with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured.
Conclusions： Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.     

Effect of Xuebijing injection on peripheral T-lymphocyte subpopulations in patients with severe trauma

Objective： To investigate the effect and clinical significance of Xuebijing injection on peripheral T-lymphocyte subpopulations in patients with severe trauma. Methods： Thirty-three patients with severe trauma were randomly divided into a control group （n=16） and a treatment group （n=17）. The patients of two groups were all treated conventionally, and the only difference was that Xuebijing injection was given to patients of the treatment group. The CD4^＋ and CD8^＋ subpopulations of T-lymphocyte in the peripheral blood were detected respectively on admission, 3rd and 5th days after trauma by double antibody labeling and flow cytometry. Results： The CD4^＋ T-lymphocytes and CD4^＋/CD8^＋ ratio of peripheral blood in patients with severe trauma decreased markedly on the 3rd and 5th days after trauma. Furthermore, compared with control group, the peripheral CD4^＋ T-lymphocytes and CD4^＋/CD8^＋ ratio of treatment group renewed obviously on the 5th day after trauma, and showed statistical differences （P〈0.05）. Conelusion： In the treatment of patients with severe trauma, the early use of Xuebijing injection is effective in correcting disorder or suppression of T-lymphocyte subpopulations regulating network, and promoting a more balanced profile of immunologic function.     

Treatment of 209 cases of liver injury

Objective: To summarize the experience of the treatment of traumatic hepatorrhexis. Methods: The clinical data of 209 cases of liver trauma treated in the three affiliated hospitals of the Third Military Medical University from 1989 to 1999 were retrospectively analyzed. Among the 209 patients, 108 (51.7%) had Grade Ⅲ or more severe liver injury. Operative treatment was performed in 186 cases and preservative treatment in 23. Results: In the operated group, 169 patients were cured. The eomplications occurred in 18 patients and 17 of them died. In the non-operated group, the complications occurred in 22 patients and only 1 of them died. Conclusions： Severe injury and delayed treatment are two major factors leading to death from liver injuries.Surgical intervention is still the principal measure to treat traumatic hepatorrhexis. The indications for non-operative treatment should be carefully selected.     

59例30岁以下原发性肺癌的临床及病理

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients.Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic carcinoma between 1969 and 2008.There were59 patients (36 male and 23 female).Mean age was 23 years ( range 8-29 ) .The ratio of men to women patients was 1.7∶1.Forty-nine cases ( 83.0% ) were symptomatic at presentation and 18 cases(30.5% )were misdiagnosed as other diseases.Surgical procedures included radical resection in 46 cases,palliative resection in 3 cases,thoracotomy only for unresectable disease in 7 cases and VATS biopsy in 3 cases.The histological types were 18 adenocarcinomas,13 carcinoids,9 mucoepidermoid carcinoma,5 squamous cell carcimomas,4 small cell lung cancer,3 adenosquamous carcinoma and 4 others.On TNM staging,8 cases in stage Ⅰa,3 cases in stage Ⅰb,9 cases in stage Ⅱ a,12 cases in stage Ⅱb,15 cases in stage Ⅲa,8 cases in stage Ⅲb,4 cases in stageⅣ.Results There were no operative death in radical group.Post-operative atelectasis in 3 cases.One case died from postoperative respiratory failure in explosive group,the postoperative five year survival rate was 27.0%.radical resection group 5-year survival was 35%.Univariate analysis identified TNM stage and surgical procedures as predictors of survival( P <0.05).factors that had no significant effect on overall survival included gender,histologic sbutype and postoperative chemotherapy (P > 0.05).The 5 year survival in stage Ⅰ,Ⅱ,Ⅲa,Ⅲb + Ⅳ were 75.0%,33.3%,14.3% and 0,respectively.The 5 year survival in lobectomy,pneumonectomy and exporsive were 43.0%,18.2% and O,respectively.On multivariate analysis,TNM stage of disease was the only independent predictor of survival ( P =0.000) .Conclusion We should pay attention to adolescent lung cancer and improve the diagnosis rate avoiding of delaying surgical treatment.The five year survival rate of radical resection for adolescent lung cancer was good.They should be treated with aggressive multimodality therapy and surgical resection is the first-line treatment for them.     

Liver Trauma: Experience in 348 Cases

Liver trauma, the main cause of death in patients suffering abdominal injury, remains an unresolved problem, especially in its most severe forms. The objective of this study was to probe effective surgical procedures and improve the outcome for patients with severe hepatic injury. A retrospective study of 348 patients with hepatic trauma seen in our institution during the past 12 years was carried out. Of these 348 patients, 259 (74.4%) underwent surgery. To manage severe liver trauma (American Association for the Surgery of Trauma grade III to grade V), procedures such as packing of the laceration with omentum, hepatectomy or direct control of bleeding vessels within the liver substance by means of the Pringle maneuver, selective hepatic artery ligation, retrohepatic caval repair with total hepatic vascular occlusion, and perihepatic packing were selected and combined based on the specific injury. In the 259 patients treated operatively, the survival rate was 86.9% (225/259); and 15 of 40 with retrohepatic venous injury (RHVI) were cured with the maximum blood transfusion of 60 units. In 42 patients treated by perihepatic packing, the bleeding was stopped in 20 of 25 (80%) with RHVI and in 14 of 17 (82%) without such injury (p > 0.75). The percentage of failure of nonoperative management was 17.2% (17/99); and it was 46.7% (14/30) in patients with grade III–V injury. Death occurred in 3 (50%) of 6 failures of grade IV–V injury. The overall mortality rate was 11.8% (41/348), and 51% of the deaths were due to exsanguination. The results suggest that severe hepatic injuries, especially grade IV–V injuries, usually require surgical intervention; reasonable surgical procedures based on classification of liver trauma and combined application of techniques can increase the survival rate; and perihepatic packing is effective in dealing with RHVI.     

严重肝脏创伤综合手术治疗

目的改善肝脏损伤手术治疗效果。方法对８年间收治的２３７例肝脏损伤患者的处理原则、手术方法及预后进行了总结。手术治疗１８０例，以大网膜填塞修补、Ｐｒｉｎｇｌｅ法阻断肝蒂后肝内止血或清创切除、肝周填塞或加选择性肝动脉结扎作为处理Ⅲ～Ⅴ级肝损伤的主要手段。结果手术治疗组存活１５４例，其中２３例肝后静脉损伤者存活８例，最大输血量１２０００ｍｌ。总病死率１１．８％，除死于合并伤外，大失血或合并凝血障碍为主要死因。结论正确操作的肝后填塞和适当的辅助措施对肝后静脉损伤具有明显治疗效果。     

Chirurgische Therapie, prognostische Faktoren und Ergebnisse beim Lebertrauma

Hepatic trauma is a rare surgical emergency with significant morbidity and mortality. Extensive experience in liver surgery is a prerequisite for the management of these injuries. The medical records of 68 consecutive patients with hepatic trauma were retrospectively reviewed for the severity of liver injury, management, morbidity, mortality, and risk factors.Of the patients, 14 were treated conservatively and 52 surgically (24 suture/fibrin glue, 16 perihepatic packing, 11 resections, 1 liver transplantation). Two patients died just before emergency surgery could be performed. Overall mortality was 21% (14/68), and 13, 14, 6, 27, and 50% for types I, II, III, IV, and V injuries, respectively. Only nine deaths (all type IV and V) were liver related, while four were caused by extrahepatic injuries and one by concomitant liver cirrhosis. With respect to treatment, conservative management, suture, and resection had a low mortality of 0, 4, and 9%, respectively. In contrast, mortality was 47% in patients in whom only packing was performed (in severe injuries). Stepwise multivariate regression analysis proved prothrombin values <40%, ISS scores >30, and transfusion requirements of more than 10 red packed cells to be significant risk factors for post-traumatic death.Type I-III hepatic injuries can safely be treated by conservative or simple surgical means. However, complex hepatic injuries (types IV and V) carry a significant mortality and may require hepatic surgery, including liver resection or even transplantation. Therefore, patients with severe hepatic injuries should be treated in a specialized institution.     

Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: Single institution 14 years experience at European trauma centre

PurposeMajor liver trauma in polytraumatic patients accounts for significant morbidity and mortality. We aimed to assess prognostic factors for morbidity and mortality in patients with severe liver trauma undergoing perihepatic packing.MethodsProspectively collected records of 293 consecutive polytrauma patients with liver injury admitted at a level I trauma centre between 1996 and 2008 were reviewed. 39 patients with grade IV–V AAST liver injury and treated with peri-hepatic packing were identified and included for analysis. Univariate and multivariate analyses were performed to assess prognostic factors for morbidity and mortality.ResultsMean age of patients was 41 years. 34 patients were haemodynamically unstable at initial presentation. Ten of 39 patients were treated with angiographic embolization in addition to perihepatic packing. The overall mortality rate was 51.3%. Liver-related death occurred in 23.1%. Overall and liver-related morbidity rates were 90% and 28%, respectively. Glasgow Coma Scale (GCS), respiratory rate, packed red blood cells (PRBC) transfusion, pH and Base Excess (BE), Revised Trauma Score (RTS) and Trauma Injury Severity Score (TRISS), need for angiographic embolization as well as early OR and ICU admission were associated with significant decrease of early mortality.ConclusionsRevised Trauma Score, haemodynamic instability, blood pH and BE are important prognostic factors influencing morbidity and mortality in polytrauma patients with grade IV/V liver injury. Furthermore, fast and effective surgical damage control procedure with perihepatic packing, followed by early ICU admission is associated with lower complication rate and shorter ICU stays in this patient population.     

A multidisciplinary approach in the management of hepatic injuries

We reviewed 87 patients with hepatic injuries who were admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from January 1995 to December 1999; 76% of them had sustained blunt trauma and 24% penetrating trauma. Their injury severity scores (ISS) ranged from 4 to 57 (mean 20.94+/-12.8); 50% of them were in shock on arrival; 8.1, 28.7, 25.3, 19.5, and 18.4% suffered from hepatic injuries graded I, II, III, IV, and V, respectively. Seventeen patients (19.5%) were successfully managed non-operatively; three of them underwent hepatic angiography, which in two revealed leakage of contrast medium from the right hepatic artery; both were successfully treated by embolization. One patient had bile leakage and collection, which was successfully treated by ultrasound-guided percutaneous drainage. Seventy patients (80.5%) underwent exploratory laparotomy; nine of them died in the operating room. Of the remaining 61 who left the operating room alive, 21 had perihepatic packing, which was frequently used in those with injuries to segments V, VI, VII, and VIII (Couinaud's nomenclature). Eight patients who had packing and one who had not died in the postoperative period. Two patients who had packing underwent subsequent hepatic angiography with embolization before successful pack removal. The overall mortality was 20.7%. The mortality in complex hepatic injuries (grades IV and V) was 13 out of 33 (39.4%). We believe that non-operative management should be considered in haemodynamically stable patients. Angiography with embolization is invaluable in improving outcome in both non-operative and operative patients. Perihepatic packing is life-saving in complex hepatic injuries that cannot be effectively treated by simple surgical procedures. Finally, ultrasound- or CT-guided percutaneous drainage of bile leakage or collections spared a number of patients from open and complicated surgery.     

肝周填塞辅助性治疗肝挫裂伤的体会(附32例分析)

目的：探讨肝周填塞治疗严重肝挫裂伤的效果及并发症的防治。方法：分析总结１９７５～１９９９年应用纱布填塞治疗３２例严重肝挫裂伤病人的临床资料。结果：一次填塞止血有效率１００％,手术治愈率７１．９％,死亡率２８．１％。膈下感染或肝周脓肿发生率３１．３％,胆漏１２．５％,再出血６．３％,无一病例死于并发症。结论：肝周填塞在严重肝挫裂伤的治疗上有着重要作用,填塞止血的效果确切,填塞引起的并发症可以防治。     

Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries

BACKGROUND: Despite continuous advances in traumatology, juxtahepatic venous injuries are still the most difficult and deadly form of liver trauma. Most deaths result from exsanguination, and reported mortality ranges from 50% to 80%. This is an evaluation on our experience with the management of this high mortality injury following a refined operative strategy. METHODS: This is a retrospective study of consecutive patients sustaining blunt juxtahepatic venous injuries. The management for these patients was mainly a refined operative strategy combined with a multidisciplinary approach. Preoperative conditions and the patient demographics were gathered. In addition, the number and type of interventional procedures, overall complications, and operative procedures were collected and analyzed. RESULTS: From January, 1996 to March, 2004, 19 patients (M:F = 13:6) with juxtahepatic venous injuries were included and all were managed operatively. The operative procedures included hepatectomy by finger fracture technique for direct repair (8), perihepatic packing (1), packing and hepatic artery embolization (1), packing and hepatic artery ligation (1), hepatorrhaphy and packing (5), packing followed by hepatectomy (2) and atriocaval shunt for direct repair (1). The survival rate for the packing group was higher than that of the direct repair group (75% versus 45%), but was not statistically significant (p = 0.352). Injury to the retrohepatic vena cava influenced the patient's survival significantly (p = 0.041). The overall survival was 58% (11/19). CONCLUSION: A well-defined operative strategy helps surgeons deal with the problem of blunt juxtahepatic venous injury, and its combination with multidisciplinary management will improve patient outcomes.     

Recent experiences with a multidisciplinary approach to complex hepatic trauma

BACKGROUND: The selection of an appropriate time to terminate damage control efforts when faced with haemorrhagic shock from severe hepatic trauma can be challenging. At our centre, trauma surgeons have increasingly been favouring an operative approach simply involving early perihepatic packing (without extensive use of intraoperative measures aimed at achieving definitive haemostasis) and temporary abdominal closure. This is often followed by hepatic arteriography with angioembolization, resuscitation, and early re-exploration under more optimal physiological conditions. This study describes the initial outcomes of this approach. MATERIALS AND METHODS: All patients with high-grade liver injury requiring operative intervention due to refractory haemodynamic instability, presenting to our trauma centre between 1995 and 2001 were reviewed. Two treatment groups: definitive laparotomy (DL), and early packing (EP) with angioembolization and re-exploration were compared, using a retrospective audit. RESULTS: Thirty-seven patients were identified with severe liver injuries requiring operative intervention (DL 30, EP 7). Patient demographics between groups were similar. The EP group was found to have lower mortality (0% versus 36.7%), but increased length of hospital stay, transfusion requirements, and complication rates. CONCLUSIONS: A multidisciplinary approach to complex hepatic trauma involving brief damage control laparotomy with perihepatic packing only, followed by angioembolization, and early re-exploration may confer a survival benefit over early operative attempts at definitive haemostasis but is associated with complications.     

严重肝外伤伴肝周大血管破裂的手术治疗

目的 探讨严重肝外伤伴肝周大血管破裂手术治疗的临床效果.方法 总结2000年12月至2008年5月解放军一零一医院收治的12例严重肝外伤伴肝周大血管破裂的临床资料,分析治疗效果.本组全部患者病例均为急诊手术.严重肝组织毁损行肝叶切除6例,其中肝右后叶切除1例,非规则性肝右叶切除1例,左半肝切除3例,左外叶切除1例,非严重的肝破裂处均以间断缝合修补.肝周血管破裂行修补术7例,其中肝后下腔静脉破裂修补术3例(经肝正中裂劈开、肝后下腔静脉修补术2例,直接行下腔静脉破裂修补术1例),门静脉破裂行间断缝合修补术2例,肝右静脉破裂行间断缝合修补术2例.肝静脉缝扎7例,其中肝右静脉并肝中静脉缝扎术1例,肝右静脉缝扎术1例,肝中分支静脉缝扎术2例,肝左静脉缝扎术3例.肝固有动脉结扎1例.肝周纱布填塞3例.结果 本组患者治愈9例,死亡3例,其中死于术中严重创伤伴出血性休克2例,死于重型颅脑伤及出血性休克1例.结论 及时手术,确切止血及正确的手术方式是抢救成功的关键.     

严重肝外伤伴肝周大血管破裂的手术治疗

目的 探讨严重肝外伤伴肝周大血管破裂手术治疗的临床效果.方法 总结2000年12月至2008年5月解放军一零一医院收治的12例严重肝外伤伴肝周大血管破裂的临床资料,分析治疗效果.本组全部患者病例均为急诊手术.严重肝组织毁损行肝叶切除6例,其中肝右后叶切除1例,非规则性肝右叶切除1例,左半肝切除3例,左外叶切除1例,非严重的肝破裂处均以间断缝合修补.肝周血管破裂行修补术7例,其中肝后下腔静脉破裂修补术3例(经肝正中裂劈开、肝后下腔静脉修补术2例,直接行下腔静脉破裂修补术1例),门静脉破裂行间断缝合修补术2例,肝右静脉破裂行间断缝合修补术2例.肝静脉缝扎7例,其中肝右静脉并肝中静脉缝扎术1例,肝右静脉缝扎术1例,肝中分支静脉缝扎术2例,肝左静脉缝扎术3例.肝固有动脉结扎1例.肝周纱布填塞3例.结果 本组患者治愈9例,死亡3例,其中死于术中严重创伤伴出血性休克2例,死于重型颅脑伤及出血性休克1例.结论 及时手术,确切止血及正确的手术方式是抢救成功的关键.