非手术治疗闭合性肝破裂92例临床分析

目的探讨闭合性肝破裂非手术治疗的可行性,总结非手术治疗的临床经验。方法回顾分析1991-10～2009-12采用非手术治疗92例闭合性肝破裂患者的临床资料。结果经非手术治疗92例患者中治愈88例,治愈率95.65%;3例并发肝周脓肿,经B超引导下肝脓肿穿刺引流、冲洗,治愈出院,并发症发生率3.26%。中转手术2例占2.17%。病死2例均伴重度颅脑损伤,出现脑疝,经抢救无效死亡。结论在严格掌握非手术治疗的适应证和密切观察伤情变化的条件下,非手术治疗闭合性肝外伤是安全可行的,能减轻伤者的手术创伤,缩短住院时间,但对非手术治疗期间血流动力学不稳定或发生延迟性出血者应及时手术。

Non-operative management of closed hepatic rupture injuries:Clinical analysis of 92 cases

Objective To investigate the probability of non-operative management of closed hepatic rupture injuries and summarize its experience.Methods The clinical data of non-operative management of 92 cases with closed hepatic rupture injuries from October 1991 to December 2009 was retrospectively analysed.Results Eighty eight cases (95.65%) were cured among them,3cases (3.26%) suffered from complications with perihepatic abscess and were cured underwent percutaneous transhepatic cholangiographic drainage(PTCD);2 cases (2.17%) transferred to operation;2 cases (2.17%) died due to severe cerebral injuries.Conclusion The non-operative management of closed hepatic rupture injuries is safe and available when indication is strictly controlled and change of injury condition is constantly observed.The non-operative treatment could avoid the wound of operation;The operation should be promptly performed when the patient's hemodynamics is unstable or delayed hemorrhage occures during the period of non-operative management.