闭合性肝损伤的治疗228例报道

目的总结闭合性肝损伤手术治疗的经验体会，进一步提高闭合性肝损伤的临床诊断和治疗抉择的水平。方法回顾性分析我院10年内228例闭合性肝损伤患者的诊治资料，调查分析了闭合性肝损伤的损伤程度和临床治疗方案抉择的关系。结果本组中97例患者经非手术治疗治愈，131例行手术治疗，非手术治愈率为100％。手术治疗131例中，死亡11例，手术治愈率91．6％（120／131），总治愈率95．2％（217／228）。结论准确进行伤情评估，早期诊断和合理的术式是闭合性肝损伤救治成功的关键。     

67例闭合性肝损伤的诊断与治疗

对12年来67例闭合性肝损伤手术资料进行分析。结果80％为交通事故和坠落伤,77.6％为肝右叶损伤,56.7％伴有多发伤,50.7％伴有失血性休克。手术所见55例为中度损伤,8例为重度损伤,肝修补为主要术式。全组治愈58例,死亡9例。闭合性肝损伤由于伤情复杂,病情凶险,故早期明确诊断是提高其治愈率的前提,积极复苏、尽快探查、合理术式及充分引流是降低死亡率及提高治愈率的关键。     

腹部闭合性损伤96例诊治体会

目的探讨腹部闭合性损伤早期诊断治疗以及提高其治愈率,减少死亡率。方法回顾性分析96例腹部闭合性损伤患者的病因、诊治及死亡原因。结果所有患者手术治疗86例,非手术治疗10例;痊愈92例、死产4例。死亡者多为复合伤。结论正确的围手术期处理,快速综合评估伤情、早期诊断、早期剖腹探查,合理选择术式是提高腹部闭合性损伤成功率、降低死亡的关键。     

67例闭合性肝损伤的诊断与治疗

对１２年来６７例闭合性肝损伤手术资料进行分析。结果８０％为交通事故和坠落伤，７７．６％为肝右叶损伤，５６．７％伴有多发伤，５０．７％伴有失血性休克。手术所见５５例为中度损伤，８例为重度损伤，肝修补为主要术式。全组治愈５８例，死亡９例。闭合性肝损伤由于伤情复杂、病情凶险，故早期明确诊断是提高其治愈率的前提，积极复苏，尽快探查、合理术式及充分引流是降低死亡率及提高治愈率的关键。     

54例成人闭合性肝损伤的临床诊疗分析

目的探讨成人闭合性肝损伤的诊治方法。方法回顾性分析许昌市建安区人民医院54例成人闭合性肝损伤患者的临床资料。结果 54例患者中,51例痊愈。非手术治疗11例,其中3例出现并发症。手术治疗43例(包括中转手术5例),8例出现并发症,死亡2例,转院1例。结论早期诊断,严密观察病情,加强血流动力学监测,严格掌握非手术治疗的适应证,对血流动力学稳定的闭合性肝损伤,采取非手术治疗是安全可行的。对血流动力学不稳定或经液体复苏后仍不稳定的患者,应及时采取手术治疗。     

132例闭合性肝损伤的诊断和治疗

目的 探讨肝损伤最佳的诊断和治疗方法。方法 回顾性总结1988—1998年10年间本院收治的肝损伤132例诊断和治疗经过。其中非手术治疗31例,手术治疗101例,手术方式包括单纯清创修补,填塞修补,肝切除术。结果 非手术治疗组中,2例因合并多器官损伤而死亡,手术治疗组中,5例死亡。结论 非手术治疗适用于轻度单纯Ⅰ-Ⅱ级肝损伤,应根据伤情具体情况,选择不同的手术治疗方案。     

手术治疗肝损伤50例体会

目的　提高肝损伤的治疗水平。方法　对我院 1986年 1月至 2 0 0 0年 7月收治经手术治疗肝损伤 5 0例的治疗进行回顾性分析。结果　本组 5 0例 ,治愈 4 7例 ,死亡 3例。死亡原因 :早期失血性休克、凝血功能障碍 1例 ,合并伤 2例。并发症 :胆瘘 2例。结论　手术治疗肝损伤应根椐伤情合理选择并正确使用不同的术式 ,重度肝损伤时常常需几种术式联合应用才能获得良好的效果     

闭合性肝损伤42例非手术治疗体会

目的探讨闭合性肝损伤非手术治疗方法。方法对42例Ⅲ级以下闭合性肝损伤病人采取包括卧床、输血、输液、抗生素、止血药应用等非手术方法治疗。结果治愈35例（83%）,中转手术6例（14%）,死亡1例（2%）,发生肝外伤相关并发症3例（7%）。结论严密观察下对Ⅲ级以下闭合性肝损伤采取非手术治疗是安全有效的。     

婴幼儿腹部闭合性损伤的诊断及治疗

目的: 探讨婴幼儿腹部闭合性损伤的诊断与治疗。方法:对婴幼儿腹部闭合性损伤84例患者的临床资料进行回顾性分析。结果:腹部闭合性实质脏器损伤60例（肝损伤32例， 脾损伤28例），小肠穿孔10例，腹壁软组织挫伤14例。非手术治疗肝损伤27例，脾损伤22例。手术治疗肝损伤5例，脾损伤6例;其他类型损伤手术10例。84例患儿均治愈出院。结论:婴幼儿闭合性腹部损伤诊治过程中，应用合理腹穿，B超，CT检查迅速明确有无内脏损伤及程度;严格掌握手术治疗适应证;实质脏器损伤非手术治疗安全可行，治愈率高。     

非手术治疗腹部闭合性损伤脾破裂

目的探讨腹部闭合性损伤脾破裂的非手术治疗的适应证及经验。方法对1996年2月一2003年6月采用非手术治疗的37例腹部闭合性损伤脾破裂的临床资料进行回顾性分析。结果37例均痊愈出院。其中非手术治疗成功34例(91．9％)，住院时间为12-23d；另3例因在非手术治疗期间由于延迟性出血引起血液动力学不稳定而中转手术治愈。结论腹部闭合性损伤脾破裂选择性进行非手术治疗是可行的，但必须严格掌握适应证和严密监测伤情的变化如在非手术治疗期间血液动力学不稳定或发生延迟性出血者应及时进行手术治疗。     

Intra-arterial thrombolysis in the carotid territory

Background: In patients who sustain abdominal trauma the liver is the most frequently injured organ. Although treatment for haemodynamically unstable patients remains urgent surgery, there has been a shift of management in haemodynamacally stable patients towards non-operative management. We performed an outcome assessment of traumatic hepatic injury.

Methods: A retrospective study was performed to assess incidence, mechanisms, management and outcome of traumatic liver injury in the region of ’s-Hertogenbosch, the Netherlands, in the period 1999–2007.

Results: A total of 47 patients were identified. Thirty-six patients had blunt hepatic trauma, eleven sustained penetrating hepatic injury. In 67% (n = 24) of the blunt hepatic trauma patients the initial intention was to treat non-operatively. Yet, two patients underwent explorative laparotomy after one and two days. In the penetrating liver trauma patients, 91% (n = 10) underwent urgent surgery. In total, 31 of 47 patients were treated conservatively.

Conclusion: Blunt hepatic trauma is the most common cause of hepatic trauma. Most patients sustaining hepatic trauma can be managed conservatively at a dedicated ICU and/or surgical trauma ward.     

Traumatic pulmonary pseudocyst. Report of twelve cases

Twelve cases of traumatic pulmonary pseudocyst were seen between January 1966 and July 1987 at Saiseikai Kanagawaken Hospital. The cause of the traumatic pulmonary pseudocyst was closed blunt chest trauma in all patients. For the first few days after the injury, computed tomographic scan was more useful in diagnosis than chest roentogenogram. Tube drainage of the pleural cavity was performed in 10 patients who had hemothorax or hemopneumothorax, and antibiotics were administered to all patients. No patient underwent a surgical procedure, and all traumatic pulmonary pseudocysts eventually resolved, without any specific treatment, within 1 to 4 months (average 1.8 month) after the trauma. We conclude that pulmonary resection is not indicated except in the rare instance in which the traumatic pulmonary pseudocyst becomes infected.     

胰腺外伤的诊治和治疗(附3例报告)

目的探讨胰腺外伤的诊断、分型和治疗。方法本文对近1年诊治的腹部外伤中胰腺外伤3例进行回顾性分析,其中1例为胰腺头体交界处横断伤,1例为胰体尾裂伤,1例为胰腺外伤误诊后假性胰腺假性囊肿形成。结果3例胰腺损伤患者,均经手术治疗后痊愈出院,无并发症发生。结论对于有上腹部外伤的患者,外科医生要警惕胰腺外伤的可能,怀疑胰腺外伤的术中应仔细探查胰腺。强调胰腺外伤的早期合理治疗,有利于减少并发症和降低死亡率,手术方式视外伤分类而定。     

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.     

腹部闭合性损伤187例诊治体会

目的探讨腹部闭合伤的诊断,治疗及如何降低病死率。方法对我院1998年1月至2003年12月闭合性腹部外伤187例进行回顾性分析,包括单一脏器损伤78例,多脏器或合并其他重要系统损伤109例。非手术治疗11例,手术治疗176例。结果痊愈178例,死亡9例。结论及时确诊,早期抗休克,合理处理多发伤是腹部闭合伤治疗的关键。     

原发性肝癌破裂出血38例诊治体会

目的 探讨原发性肝癌自发性破裂出血的诊断和治疗方法。方法 回顾性分析本院自1996年7月至2004年7月收治38例原发性肝癌破裂出血的临床资料。结果 38例患者中9例行保守治疗,术后病死率为67％（6／9）：29例行手术治疗,手术方法有不规则肝切除术,肝动脉结扎＋填塞缝合止血术,单纯填塞缝扎止血术,术后病死率分别为25％（3／12）,56％（5／9）,62％（5／8）。结论 原发性肝癌破裂出血行肝切除术不但可以有效彻底地止血,而且可以达到切除病灶的目的,是一种安全,可行的方法。如果病人情况不允许,可先行保守治疗,争取行Ⅱ期或延期肝切除术。     

Surgical management of complex liver trauma: a single liver transplant center experience

Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to V according to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.     

Patterns of organ injury in blunt hepatic trauma and their significance for management and outcome

Analysis of 185 consecutive patients admitted to a trauma center (1983-1986) with blunt traumatic injury to the liver classified by severity of hepatic injury (I-V) has demonstrated that the pattern of associated organ injuries is a major determinant of the immediate resuscitation requirements, complications, and the ultimate outcome of patients with hepatic injury. When the significance of all injuries and major complications was evaluated using simultaneous ANOVA techniques, only brain and chest trauma together were significant (p less than 0.03) as injuries occurring in subsequently fatal cases for all classes of blunt hepatic injury. Sepsis (p less than 0.05) and ARDS (p less than 0.005) were significant complications associated with death in the patients who survived the initial operative intervention, and only brain deterioration and exsanguinating hemorrhage were significant (p less than 0.0001) as direct causes of death in all groups of patients. It was of interest that neither associated bowel, spleen, stomach, or pancreatic injuries had a significant difference in incidence between survivors and deaths. Overall, the most important single injury determining ultimate outcome was blunt traumatic injury of the brain. Review of the resuscitation and operative intervention strategies, postoperative complications, and causes of death shows that the interactions between the class of liver injury and the injuries to other organs, primarily brain and lung, are the determinant of the optimization of postinjury therapy of both a surgical and critical care nature.