肝脏外伤的20年诊治体会

目的 总结肝脏外伤的诊治经验.方法 回顾性总结1988年1月～2007年12月260例肝脏外伤病例的临床资料,包括损伤程度、治疗方式、治疗效果和并发症等.结果 经开放于术治疗153例,非手术治疗107例.236例治愈,24例死亡,病死率为10.2%,其中,肝脏损伤Ⅰ～Ⅱ级139例,死亡0例;Ⅲ-Ⅴ级119例,死亡22例;Ⅵ级2例均死亡,死亡与肝脏损伤级别相关.并发症发生82例次,主要包括继发性出血、腹腔感染等.结论 血流动力学稳定的肝脏外伤患者可在有效监护下选择非手术治疗,血流动力学不稳定的患者应及时于术止血,多学科的协作处理可扩大非手术治疗的应用,减少并发症.

Twenty-year experience in the diagnosis and treatment of hepatic trauma

Objective To summarize the experience in the diagnosis and treatment of hepatic trauma. Methods The clinical data of 260 patients with hepatic trauma admitted from January 1988 to December 2007 were retrospectively reviewed with regard to degree of trauma, treatment methods, therapeutical effects, complications and SO on. Results One hundred and fifty-three eases were treated by operative management,1 07 cases by nonoperative management.236 cases were cured,24 cases died,and the case fatality rate was 10.2%.There were no death among 139 patients with hepatic trauma grades Ⅰ～Ⅱ,22 death among 119 grades Ⅲ～Ⅴ patients, all death of 2 in grade VI, which demonstrated the correlation between death and hepatic trauma grade was statistically significant. Complications appeared in 82 eases, mainly including Secondary hemorrhage, abdominal infection and so on. Conclusions Nonoperative management is suitable for hepatic trauma with stable hemodynamics. Operative management is rapidly selected when the hemodynamics aren't stable. The cooperation of many specialities can enlarge the application of nonoperative management and decrease complications.