肝外伤的治疗策略探讨

目的 探讨肝外伤的治疗策略.方法 回顾性分析1997年1月至2008年1月收治的112例肝外伤患者的临床资料.根据美国创伤外科学会(AAST)分级标准,对加例血流动力学稳定的Ⅰ～Ⅱ级肝外伤患者行非手术治疗,48例Ⅱ～Ⅳ级肝外伤患者行肝修补术治疗,13例Ⅳ～Ⅴ级肝外伤患者行肝部分切除术或联合选择性肝动脉结扎术,11例Ⅳ～Ⅴ级肝外伤患者行肝周纱布填塞或再加选择性肝动脉结扎的损伤控制性手术.结果 手术治疗72例患者中治愈60例,死亡12例;非手术治疗40例患者全部治愈.结论 非手术治疗是血流动力学稳定的肝外伤患者治疗的重要手段;外科手术是严重肝外伤患者治疗的主要措施.根据术中情况正确选择术式、损伤控制性手术、积极处理合并伤是提高严重肝外伤患者抢救成功率的关键.

Management strategy of hepatic trauma

Objective To explore the management strategy of hepatic trauma. Methods From January 1997 to January 2008, a retrospective study was performed on 112 cases of hepatic trauma. Base on the classification of AAST,non-operative treatment was used in 40 hemodynamic steady patients (grade Ⅰto Ⅱ), hepatic repair was therapeutic method to grade Ⅱ to Ⅳ (48 cases), while hepatectomy or plus selective ligation of hepatic artery were chosen for grade Ⅳ to Ⅴ (13 cases). Peripheral hepatic tamping or plus selective ligation of hepatic artery were effective therapeutic approaches to grade Ⅳ to Ⅴ (11 cases) according to damage control surgery. Results In the operative case.s, 60 cases were cured, 12 died. All non-operative cases were cured. Conclusions Non-operative management is widely becoming one of the most important strategies in the treatment of hepatic trauma with stable hemodynamics. Surgical intervention is still the principal measure of treatment for severe hepatic trauma. According to specific condition, appropriate operative procedures, damage control surgery and prompt management of associated injury will earn a higher success rate.