小儿肝脾损伤的非手术治疗--附44例临床分析

目的 探讨小儿肝脾损伤的诊断和非手术治疗手法。方法 分析１９８８年１月￣１９９８年１０月收治肝脾损伤患儿４４例。结果 肝脏损伤２０例，腹腔穿刺阳性率９２．９％，肝包膜下血肿１２例（６０．０％），肝破裂，实质内血肿８例（４０．０％），平均输血量在２０ｍｌ／ｋｇ以下。

Nonoperative management of blunt hepatic and splenic injury in pediat ric patients, analysis of 44 cases

Objective To appraise the method for diagnosis and nonoperative management of blunt hepatic and splenic injuriey in pediatric patients.Methods By analyzing the data of 44 children with blunt liver and spleen injury who were admitted from January 1988 to October 1998. Results 20 children had injury of the liver, Possitive abdominal puncture was 92.9%, among these, 12(60%) had subcapsular hematoma, 8(40%) had intra parenchymatous hematoma. All these were treated conservatively, the mean volume of trasfusions was below 20ml/kg. 26 children had jnjury of the spleen (2 had both hepatic and splenic injuries), positive adbominal puncture was 84.2%, 6 children(23.1%) had subcasular hematoma, 12 children (46.2%) intrasplenic hematoma. In nonoperative group, the mean volume of transfusion was between 10 to 30ml/kg; that of operative group was 20 to 25 ml/kg. The successful rate of non opreative treatment was 88.5%. Conclusion Nonoperative management of hepatic and splenic injury in pediatric patient had a high rate of success. Adbominal puncture provides the clue to visceral hemorrhage, care should be taken to watch for the dynamic changes of blood pressure, heart rate, respiretory rate, heamoglobin and hematocrit which are beneficial for making decision of laparotomy or continuation of conservative management.