185例肝脏损伤综合手术治疗体会

目的探讨肝脏损伤的治疗方法,改善肝脏损伤手术的疗效。方法对2006年1月~2015年12月重庆市急救医疗中心创伤科收治的185例肝脏损伤手术患者的处理原则、手术方式及治疗结果进行总结,其中男性149例,女性36例;年龄15~79岁,平均37岁。按美国创伤外科学会(AAST)制订的肝损伤分级标准:Ⅰ级19例,Ⅱ级31例,Ⅲ级59例,Ⅳ级48例,Ⅴ级28例(其中合并肝后静脉损伤17例)。肝损伤AIS评分平均为(3.19±1.19)分。多发伤患者ISS评分平均为(18.76±6.64)分。以肝修补、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肝脏损伤的主要手段。结果本组存活163例,死亡22例,死亡率11.89%。其中17例合并肝后静脉损伤者存活9例。死亡患者中除死于严重合并伤外,大失血或合并凝血障碍为主要死因。结论依据肝脏损伤的分级选择手术方案,肝后静脉损伤进行确切的肝后填塞和适当的辅助措施可提高救治成功率。

Surgical therapy for hepatic trauma:experience of 185 cases

Objective To discuss and improve the result of surgical therapy for patients with hepatic injury.Methods Retrospective analysis was made on the result of surgical treatment of 185 patients with hepatic trauma during Jan.2006 and Dec.2015. There were 149 males and 36 females;their age ranged from 15-19 years,with an average of 37 years.According to the American Association for the Surgery of Trauma (AAST),19 patients were grade I,31 were gradeⅡ,59 were grade Ⅲ,48 were grade Ⅳ and 28 were grade Ⅴ(including 17 patients with post-hepatic vena injury).The average score of AIS for hepatic trauma was (3.19±1.19).The average score of ISS for patients with multiple trauma was (18.76±6.64).Hepatic injury was mostly managed by hepatic repair,epiploon tamponade,Pringle's maneuver before blood control,debridement hepatectomy,perihepatic packing and selective hepatic artery ligation.Results Among the 185 patients,163 were cured and 22 died,the overall mortality rate was 11.89％(22 of 185 patients).Nine out of 17 patients with post-hepatic vena injury were cured.Besides associated injuries inside and outside the abdomen,exsanguination or associated coagulopathy was the main cause of death.Conclusion The reasonable surgical procedures should be based on classification of liver trauma.Accurate perihepatic packing with appropriate adjunctive procedures is effective in the treatment of post-hepatic vena injury.