外伤性肝破裂的综合外科治疗

目的 提高外伤性肝破裂的外科治疗水平。方法 从1987年9月～2001年1月共收治外伤性肝破裂210例,现将其外科处理原则,手术方法的选择,非手术治疗的指征以及治疗结果进行回顾性分析。结果 本组病例采用综合手术治疗198例,其中治愈182例,治愈率为91.9％;死亡16例,病死率为8.1％。主要死亡原因为严重休克及严重合并伤。非手术治疗12例,全部治愈。结论 采用综合手术冶疗可明显提高手术成功率和减少并发症率。清创术加大网膜填塞肝修补术,肝修补术,选择性肝动脉结扎及不规则肝切除是治疗外伤性肝破裂的主要手段。严格掌握非手术治疗的适应证可以提高治愈率。

Complex surgical treatment of traumatic repture of the liver

To improve the level of surgical therapy for patients with traumatic rupture of the liver.Methods From 1987 September to 2001 January,210 cases of traumatic rupture of the liver in the princi-ple of surgical management, therapeutic results and non-operative indications were analyzed retrospectively. Re-sults Among 198 patients of complex surgical treatmemt, 182 cases were cured. The cured rate was 91.9%. There were 16 cases of death, who died from serious shock and severe associated injuries. The mortality was 8.1%. Twelve patients of non-surigcal management were cured totally.Conclusion The complex surgical treatment could improve the successful rate of operation and reduced the complicated rate. When the indications of non operative management were grasped strictly,the cured rate would be improved. A chief means for treating traumatic rupture of the liver was debridment plus filling with omentum and repair,hepatic repair,selective liga-tion of hepatic artery and irregular hepatectomy.