肝外伤160例临床分析
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牟洪超

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Treatment of liver trauma: a report of 160 cases
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    摘要:

    目的:探讨肝外伤的诊断和治疗方法。
    方法:回顾性分析160例肝外伤患者的临床资料,其中闭合性肝损伤96例和开放性肝损伤64例。
    结果:160例肝外伤中1例Ⅳ级伤因合并严重胸廓挤压伤入院后30 min内死亡,其余159例中Ⅰ~Ⅲ级损伤45例(Ⅰ级9例,Ⅱ级31例,Ⅲ级5例),采用非手术治疗,并发症4例(8.9 %),均治愈,治愈率100 %;手术治疗114例,其中Ⅱ级7例,Ⅲ级67例,Ⅳ级20例,Ⅴ级8例,Ⅵ级12例,治愈112例(98.2 %),发生各类并发症共7例(6.1 %):术后并发ARDS死亡1例,术后再出血2例(1例死亡,1例痊愈);另肝脓肿2例,胆瘘2例,经治疗痊愈。死亡2例(1.8 %)。
    结论:对肝外伤诊断的检查应以腹腔穿刺加B超为首选,条件允许时可行腹部CT检查。对血液动力学稳定的I和II级、部分III级损伤可在严密监测下行保守治疗;部分II级损伤、大部分III级损伤、所有Ⅳ~VI级损伤以行手术治疗为宜。

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    Abstract:Objective:To explore the diagnosis and treatment of liver trauma.
    Methods :A retrospectively analysis of clinical data of 160 cases of liver trauma, including 96 cases of blunt trauma and 64 cases of open trauma, was made.
    Results:Among the 160 cases, one case with stage IV trauma and severe thoracic injury died 30min after admission. Among the other 159 cases, 45cases (9 cases of stage Ⅰ, 31 cases of stage Ⅱ and 5cases of cases Ⅲ) received nonoperative treatment, and 114cases (7 cases of stage Ⅱ, 67 cases of stage Ⅲ and 50 cases of stage Ⅳ) received operative therapy. In non-operative treatment group, the cure rate was 100 %(45/45). In operation treatment group the cure rate was 98.2 %(112/114), the mortality rate was 1.8 %(2/114), 1 case died of hemorrhage after operation and 1 case died of ARDS. Five patients with postoperative complications were cured, including hepatic abscess in 2 cases, biliary fistula in 2 cases, and hemorrhage after operation in 1 case.
    Conclusions:B-ultrasound is the method of choice for diagnosis of liver trauma, and CT can be used if conditions permit. Cases of lives truma of stages Ⅰ and Ⅱ and some cases of stage Ⅲ that have stable hemodynamics, can receive nonoperative treatment under close observation. Some cases of stage Ⅱ, most cases of stage Ⅲ and all cases of stages Ⅳ to Ⅵ injury should preferably undergo surgical treatment.

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牟洪超, 周辉, 孙茂, 董立军.肝外伤160例临床分析[J].中国普通外科杂志,2007,16(12):12-117.
DOI:10.7659/j. issn.1005-6947.2007.12.012

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  • 在线发布日期: 2007-12-25