严重肝外伤的诊断与手术策略

目的 探讨严重肝外伤的诊断与治疗方法。方法 回顾性分析1988年1月～2001年12月经手术治疗的69例严重肝外伤患者，对早期诊断及手术方法进行总结。结果 按AAST肝外伤分级，Ⅲ级38例、Ⅳ级20例、Ⅴ级11例，伴合并伤41例(51．9％)，均手术治疗。治愈57例(82．6％)，死亡12例(17．4％)，死亡原因为术中失血性休克3例．术后继发出血3例，MODS4例，脑疝2例。结论 诊断性腹穿，B超、CT以及血液动力学是诊断严重肝外伤的基本方法，综合手术治疗是救治严重肝外伤的重要手段。

Diagnosis and operative tactics of severe liver trauma

Objective To investigate the diagnosis and treatment of severe liv er trauma. Methods From January 1988 to December 2001,69 patients with severe li ver trauma were analyzed retrospectively and the early diagnosis and operation m ethod were summarized.Results The operations were performed in all eases,57 case s were cured(82.6%),12 cases died(17.4%).The causes of death were hemorragi c shock in 3 cases,postoperative secondary hemorrhage in 3 cases,MODS in 4 cases ,cerebral hernia in 2 cases. Conclusion The diagnostic abdominocentesis,ultrasou nd examination,CT scan and hemodynamics monitoring are essential method for diag nosing severe liver trauma.Combined operative treatment is an important measure to rescue severe liver trauma.