肝外伤的手术治疗

目的探讨不同类型的肝外伤的有效治疗方法。方法分析２６年手术治疗肝外伤１８２例的临床资料。结果本组死亡３５例，死亡率１９２％。本组资料显示，肝外伤的预后与术前休克，肝损伤程度，腹腔内出血量以及合并器官损伤及其数目等因素有关。结论肝实质的损伤往往超过肝表面损伤的范围。纱布填塞止血死亡率高（６／８），且易继发肝周感染，故不宜提倡。严重肝外伤规则性肝切除死亡率高于清创式肝切除。肝外伤伴肝后腔静脉损伤者，治疗困难且死亡率高，宜在改良法全肝血流阻断下行清创式肝切除后，在直视下修补

Surgical treatment of hepatic trauma

Objective To study the operative therapy for different type of hepatic injury. Methods The clinical data of 182 cases of hepatic trauma admutted to our hospital during the past 26 years were analysed retrospectively. Results There were 35 patients (19.2%) death in this series. The data showed that the prognosis of hepatic trauma was correlated to preoperative shock, severity of the hepatic injury, the volume of intraabdominal bleeding, and the number of other injuried organ(s). The hepatic trauma was found more profound and wide in hepatic parenchyma than that on the liver surface. Conclusions Sponges pressing hemostasis is not recommended either because of its high postoperative mortality(6/8) or easily to complicated with preihepatic infection. The postoperative mortality of regular liver excision after severe hepatic trauma was much higher than that of debride liver excision. Hepatic injury companied with postheaptic vein injury is difficult to treat, because of a high postoperative mortality. The authors successively treated 4 cases of posthepatic vein injury with direct repair after debride liver excision under a modified total hepatic circulation blocking.