非手术治疗肝外伤49例分析

目的 探讨肝外伤非手术治疗的适应证、治疗措施和效果.方法 回顾性分析采用非手术治疗49例肝外伤患者资料,其中按美国创伤外科协会分级标准Ⅰ级26例,Ⅱ级19例,Ⅲ级3例,Ⅳ级1例.结果 49例全部治愈,其中非手术治愈46例,占93.88％,包括介入治疗5例(肝动脉栓塞治疗3例,穿刺置管引流2例)；中转手术3例,占6.12％,为血肿破裂引起大出血.并发症4例,肝脓肿1例,穿刺置管引流治愈；胸腔积液2例,1例经胸腔穿刺后治愈,1例自行吸收；胆瘘1例,穿刺置管引流治愈.结论 对Ⅰ、Ⅱ级及部分Ⅲ级肝外伤患者行非手术治疗安全、可行,血流动力学稳定是治疗的基础,严格掌握适应证是治疗的关键.

Clinical analysis of non-operative treatment of hepatic trauma in 49 cases

Objective To explore the indications,treatment measures and effects of surgical therapy in hepatic trauma.Methods The clinical data of 49 patients with hepatic trauma treated by non-operative therapies were retrospectively analyzed.Among them,there were 26 cases of AAST grade I,19 cases of grade Ⅱ,3 cases of grade Ⅲ and 1 case of grade Ⅳ.Results All 49 cases were cured.46 cases were cured by non-operative treatment(93.88%),including 5 cases of interventional therapy(3 cases of hepatic arterial embolism and 2 cases of percutaneous catheter drainage).3 cases of massive bleeding caused by hematoma rupturing were converted to operation,accounting for 6.12%.The complications were in 4 cases.1 case of liver abscess was cured by percutaneous catheter drainage.In 2 cases of pleural effusion,1 case was cured after thoracocentesis and another case was voluntarily absorbed.1 case of biliary fistula was cured by percutaneous catheter drainage.Conclusion For grade I,grade Ⅱ and partial grade Ⅲ hepatic trauma,non-operative treatment is safe and feasible.Stable hemodynamics of the patients should be the basis of treatment.The key point of treatment is to strictly master the indications.