严重肝损伤46例救治探讨

目的总结严重肝损伤救治的临床经验。方法对1991年1月以来46例严重肝损伤病人手术治疗的临床资料进行回顾性分析。其中肝创面清创加带蒂大网膜、明胶海绵填塞缝合术34例,清创性肝切除13例,不规则肝叶切除术5例,肝周纱布填塞4例,肝后静脉修补3例,附加肝固有动脉结扎10例。结果治愈39例,死亡7例,死亡率15.2%。结论快速有效复苏、缩短术前时间、正确选择手术方式、积极处理合并伤等,可提高救治成功率。间歇性阻断肝蒂后行肝清创止血或清创性肝切除、肝周或肝后纱布填塞加肝动脉结扎,可作为救治严重肝损伤的主要方法。

Urgent treatment of severe liver injury

Objective To sum up the clinical experience in urgent treatment of severe liver injury. Methods The clinical data of 46 patients with severe liver injury underwent surgery were analyzed retrospectively from January 2001. Debriding suture plus packing suture of pedicle greater omentum and absorbable gelatin sponge was performed on 34 cases. Debridement hepatectomy was performed on 13 cases.Anomaly hepatectomy was performed on 5 cases.Perihepatic packing suture of gauze tamponadewas was performed on 4 cases. Rethepatic venous was repaired in 3 cases. Hepatic artery was ligated in 10 cases. Results 39 patients were cured, 7 died with mortality rate of 15.2%.Conclusion Rapid and effective resuscitation, shortened preoperative time, appropriate operative pattern and effective resuscitation, shortened preoperative time, appropriate operative pattern and prompt management of the associated injury may achieve higher curative rate. After intermittent occlusion of the hepatic pedicle, hepatic debridement or hepatectomy, gauze packing of around or behind liver with hepatic artery ligation can be the main methods for severe liver injury.