严重肝脏创伤综合手术治疗

目的改善肝脏损伤手术治疗效果。方法对８年间收治的２３７例肝脏损伤患者的处理原则、手术方法及预后进行了总结。手术治疗１８０例，以大网膜填塞修补、Ｐｒｉｎｇｌｅ法阻断肝蒂后肝内止血或清创切除、肝周填塞或加选择性肝动脉结扎作为处理Ⅲ～Ⅴ级肝损伤的主要手段。结果手术治疗组存活１５４例，其中２３例肝后静脉损伤者存活８例，最大输血量１２０００ｍｌ。总病死率１１．８％，除死于合并伤外，大失血或合并凝血障碍为主要死因。结论正确操作的肝后填塞和适当的辅助措施对肝后静脉损伤具有明显治疗效果。

Complex surgical therapy for severe hepatic trauma

OBJECTIVE: To improve the result of surgical therapy for patients with severe hepatic injury. METHODS: Retrospective analysis was made on the result of surgical treatment of 237 patients with hepatic trauma during the past 8 years. 180 patients underwent surgery. Procedures such as packing with the omentum for the laceration of hepatic parenchyma, debridement or irregular hepatectomy under the direct control of lacerated hepatic blood vessels or Pringle's maneuvre and selective ligation of hepatic artery were used for patients with severe hepatic injury (Grad III-V). RESULTS: Among the 180 patients, 154 were cured, and 8 of 23 with posthepatic IVC injury were cured with the maximum blood transfusion of 12,000 ml. The overall morality rate was 11.8%(28 of 237 patients). Besides associated injuries inside and outside the abdomen, exsanguination with or without coagulopathy was the main cause of death. CONCLUSION: Accurate liver packing with appropriate adjunctive procedures is effective in the treatment of retrohepatic venous injury.