手术治疗严重肝外伤36例体会

目的：探讨严重肝外伤的手术方式和治疗效果。方法：回顾性分析1993年5月～2006年5月我院手术治疗的严重肝外伤患者36例，AAST Ⅲ级者17例，Ⅳ级者14例，Ⅴ级者5例。结果：采用肝破裂清创缝合止血15例，清创加带蒂大网膜、明胶海绵填塞缝合9例，清创性肝切除7例，纱布填塞3例，肝后下腔静脉、肝静脉主干缝合修补2例。手术治愈29例，治愈率为80．56％，死亡7例，死亡率为19．44％，死于多器官功能障碍综合征（MODS）3例、败血症1例、失血性休克1例、继发性出血2例。术后出现并发症11例（发生率为30．56％），其中，并发膈下感染4例，肝脓肿2例，胆瘘1例，再出血2例，MODS 2例。结论：手术是治疗严重肝外伤的有效方法，手术方式应根据具体情况合理选择，加强对合并伤及术后并发症的管理对降低严重肝外伤的死亡率具有重要意义。

Experience of operative treatment for 36 cases of patients with severe liver trauma

Objective： To explore the methods of operation and the effects of treatment for severe liver trauma. Methods： 36 cases of patients with severe liver trauma with operative treatmant in our hospital from May 1993 to May 2006 were studied retrospectively.According to the AAST Grading of Liver Injuries,17 cases of grade Ⅲ ,14 cases of grade Ⅳ and 5 cases of grade Ⅴ. Results： Different operations were performed as following：debridement suture of hepatorrhexis in 15 cases, debfidement with greater omentum or gelatin sponge packing in 9 cases,resectional debridement in 7 cases,gauzes packing in 3 cases,suture of inferior vena cava in posterior segment of liver and hepatic vein stem in 2 cases,29 cases were cured（cure rate was 80.56%）,7 cases died（mortality was 19.44%）.The causes of death were multiple organ dysfunction syn- drome（MODS） in 3 cases, septemia in 1 case,hemorrhagic shock in 1 case and secondary bleeding after operation in 3 cases. Postoperative complications were l 1 cases（incidence rate was 30.56%）,including 4 cases of subphrenic infection,2 cases of liver abscess,1 case of biliary fistula,2 cases of reheamorrhagia and 2 cases of MODS. Conclusion： Operation is the effective treatment for severe liver trauma.The methods of operation should be choosed correctly according to the specific conditions.It is significant for reducing the mortality of severe liver trauma to strengthen the management of associated injury and postoperative complications.