肝脏损伤的诊断治疗策略

肝脏损伤手术治疗有较高的并发症发生率和死亡率,其治疗策略在过去几十年发生了转变,非手术治疗越来越多地被接受。但对创伤超声重点评估法(FAST)评估腹腔积血并伴有血流动力学状态不稳定、有明显腹膜炎症状的患者需行急诊剖腹探查术。非手术治疗肝脏损伤分级在Ⅳ~Ⅴ级的患者有较高的并发症发生率,需及早地发现并相应处理。手术治疗严重肝脏损伤成功的关键在于合理选择手术方式和及时运用损害控制理念和策略。肝后静脉损伤的主要对策是全肝血流阻断或转流下肝切除或肝切开显露和修补肝后静脉;难以耐受此术式时,肝周填塞是明智的选择。

Strategy of diagnosis and treatment for liver trauma

Surgical intervention of liver trauma has a high liver-related morbidity and mortality, and nonop-erative methods have been more and more accepted as therapeutic strategies in the past decades.However,emergen-cy exploratory laparotomy should be performed if there is unstable hemodynamics and obvious peritonitis indicated by focused abdominal sonography for trauma(FAST).Non-operative treatment of liver injury in patients with Ⅳ-Ⅴgrade had a higher incidence of complications,which should be early discovered and properly treated.The key of surgical treatment for severe liver injury is reasonably selecting surgical approach and timely applying damage control concepts and strategies.The main measure for hepatic vein injury is total hepatic blood flow blockage or liver resec-tion through by-pass procedure or hepatotomy to expose and repair retrohepatic vein.If patients are not able to toler-ate this surgery,it is wise to apply peri-hepatic packing.