外伤性肝破裂232例诊治分析

目的:总结外伤性肝破裂的诊治体会。方法:回顾性分析232例外伤性肝破裂患者的临床资料。结果:非手术治疗42例及腹腔镜探查33例患者均治愈。开腹手术157例,术中因心跳呼吸停止行心肺复苏术26例,9例复苏失败,17例复苏成功;复苏成功后痊愈10例,死亡7例;术后二次手术止血7例;并发胆瘘59例、肝周脓肿10例,胆瘘和肝周脓肿经穿刺或放置引流管引流后均痊愈;开腹手术中死亡28例,其中死于术中失血性休克难以逆转11例,死于术后再出血3例,肝叶切除加肝动脉结扎术后因黄疸、腹水、肝功能衰竭死亡3例,右三叶切除术后肝、肾功能衰竭死亡2例,多脏器功能衰竭死亡4例,因创伤性湿肺致呼吸衰竭死亡3例,严重颅脑损伤死亡2例。结论:外伤性肝破裂的诊断需综合症状、体征、实验室检查、影像学检查等多方面信息,准确地进行严重程度分级,根据患者的具体情况,采取不同的处理方法,可取得满意效果。

Summarization of the diagnosis and therapy on traumatic liver rupture in 232 cases

Objective： To summarize the diagnosis and therapy on traumatic liver rupture,to comprehend remedy for severe associated injury. Methods： A retrospective clinical analysis was made in 232 cases with traumatic liver rupture who had been treated at the 91th central hospital of PLA from Jul 2000 to Jul 2011. Results： The cases both in non-surgical treatment group （42 cas- es） and laparoscopic approach group（33 cases）were cured. There were 157 cases in the laparotomy group. There were 26 cases that were subjected to cardiopulmonary resuscitation due to cardiopul- monary arrest when laparotomy surgery was in progress, 9 of them were failure, 7 of 17 survivor died at postoperative convalescence. There were 7 cases that had to undergo secondary surgery dueto postoperative bleeding, 59 cases supervened postoperative biliary fistula, 10 with liver abscess. There were 28 cases died in the laparotomy group, include 11 cases died of failure to anti-hemor- rhagic-shock treatment, 3 of postoperative bleeding, 3 cases that underwent hepatolobectomy and HAL died of choloplania, ascites, and then liver function failure, 2 underwent right trisegmentectomy succumb to hepatic renal failure, 4 of MQDS, 3 of RF period period following traumatic wet lung, 2 of severe craniocerebral injury, Conclusions： To diagnose of traumatic liver rupture need compre- hensive analyse of symptoms, signs, laboratory tests, imaging inspection and so on, and accurate grade. In order to obtain satisfactory result, we should to adopt different approach according every patient＇ s concrete condition.