肝外伤伴肝周大静脉损伤的手术策略探讨

目的分析肝外伤伴肝周大静脉损伤的临床资料,探讨手术策略。方法收集17例肝外伤伴肝周大静脉损伤患者的临床资料,根据AAST分级和ISS评分,分析死亡原因、手术方式和疗效。结果患者ISS平均值为(40.6±10.5)分,总死亡率35.3%(6例)。Ⅳ级中死亡3例,Ⅴ级中死亡3例。根据术式不同,分成肝周纱布填塞组和大静脉修补组;2例死于纱布填塞组(40%),4例死于大静脉修补组(33%)。比较两组间的术中失血量和ISS值,纱布填塞组的均数都高于大静脉修补组。结论如何成功止血是手术关键,合理的手术策略有助提高抢救成功率。

SURGICAL STRATEGY OF LIVER TRAUMA WITH JUXTA HEPATIC VENOUS INJURY

Objective To analyze the cases of liver trauma with juxta hepatic venous injury and explore surgical strategy. Methods According to AAST grade and ISS, 17 patients with severe liver trauma were retrospectively analyzed of the causes of death, the surgical approach and efficacy. Results The average ISS was 40. 6 ± 10. 5, and total mortality was 35.3% （6 cases） ; 3 died in grade IV, and 3 died in gradeV. According to surgical approach, patients were divided into perihepatic gauzes packing group and venous repair group; 2 died in gauze packing group （40%）, 4 died in venous repair group （33%）. Compared with operative haemorrhage and ISS, mean of gauzes packing group was greater than that of venous repair group. Conclusion The success of hemostasis is the key of surgery, and reasonable surgical strategy helps to improve the success rate of rescue.