27例高龄创伤性肝破裂患者的诊治分析

[目的]探讨老年人创伤性肝破裂的诊断与治疗方法,为临床提供方法。[方法]回顾性分析浙江省湖州市中心医院2001年5月至2011年5月收治的27例老年创伤性肝破裂患者的病例特点、诊断方法、治疗手段等临床资料,进行总结归纳。[结果]非手术治疗组12例中,11例治愈,1例患者出现心衰后死亡;15例手术患者治愈10例,术中死亡2例,术后2例死于心肺功能衰竭后的多器官功能衰竭,1例因严重颅脑损伤死亡。术后1例患者出现胆瘘并继发肝周脓肿和肺部感染,单发肝周脓肿1例,单发肺部感染1例,应激性溃疡出血1例。住院时间18～45d,平均26d。[结论]老年人肝破裂病情凶险复杂,处理困难,应尽量早诊断早治疗,根据病情选择适当的治疗方案,同时注意合并伤的处理以及既往疾病的变化。

Diagnosis Analysis to 27 Cases of Senile Traumatic Hepatic Rupture

[Objective] To observe the diagnosis and treatment of senile traumatic hepatic rupture.[Methods] Trace back and analyse the features,diagnosis,therapy and other clinical data of 27 such cases,then make summary.[Results] In non-operation treatment group 12 cases,11 were cured,1 dead with heart failure;in 15 cases of operation,10 cured,2 dead in operation,2 dead with multi-organ failure,1 died with severe craniocerebral injury;1 had gallbladder fistula,secondary onset of anal abscess and lung infection;1 had only anal abscess,1 had only lung infection;1 had stress ulcer.The in-hospital period was 26d in average.[Conclusion] Senile hepatic rupture is dangerous and complex,hard to deal with,shall be diagnosed and treated as early as possible,meanwhile pay attention to proper therapy,complications and prior diseases.