严重肝外伤的外科处理

目的 :探讨严重肝外伤治疗的有效途径。方法 :回顾性分析 2 1年间 92例严重肝外伤的资料。结果 :84例严重肝外伤者采用手术治疗 ,8例采用非手术治疗 (NOM)。 77例治愈 (83.5 % )。 15例死亡 (16 .5 % ) ,并发症发生 30例 (31.5 % ) ,平均住院天数 2 2 .3d。结论 :B超是诊断钝性肝外伤的有效方法 ,在血液动力学稳定的情况下行CT检查 ,对伤情复查尤为重要。手术治疗止血是关键环节 ,术中彻底清除失活组织 ,是减少术后并发症的有效措施 ,若出现难以控制的出血 ,可采用暂时性的填塞压迫止血。若积极抢救仍不能纠正低血压时阻断上段腹主动脉是一有效措施。严重肝外伤有条件的可选择NOM。

Surgical management of serious hepatic injuries

Objective To explore an effective method of treating serious hepatic injuries. Methods A retrospective analysis was conducted on 92 consecutive cases of serious hepatic injuries during recent 21 years.Results Eighty four cases were treated with operation, and 8 cases with nonoperation management (NOM). Of these patients, 77 (83.5%) were healed, and 15 (16.5%) died. There were complications in 30 patients (31.5%). Hospital stay was 22.3 days. Conclusion Ultrasonography is a valuable diagnosic measure for hepatic injuries. When hemodynamic was stable, CT scanning was especially necessary for patients with complex injuries. Hemosatasis is a key measure during operation. Debridement of nonviable hepatic parenchyma is effective managemrent for the decrease of operative complications. If hypotension cannot be corrected actively, clamping of the upper abdominal aorta is an effective measure for patients with hepatic injuries. Serious hepatic injuries can be treated with NOM selectively.