严重外伤性肝破裂的手术方式选择.pdfVIP

中国医药2014 年5 月第9 卷第5 期 China Medicine. Mav 2014. Vol. 9. Nι5 .677 . .论著· 严重外伤性肝破裂的手术方式选择 吕俊生 [摘要] 目的 探讨严重外伤性肝破裂的个体化手术方式。方法 回顾分析 1999 年9 月至2013 年 9 月北京市顺义区医院与佳木斯大学第一附属医院收治的 35 例严重肝外伤患者的临床资料，其中闭合性 损伤32 例，开放性损伤3 例。其中车祸伤21 例，高处坠落伤5 例，钝物伤5 例，刀刺伤4 例。 35 例均合并 其他脏器损伤。结果 35 例患者术前经腹部B 型超声、诊断性腹腔穿刺检查疑诊为肝破裂，均经剖腹探查 确诊。严重肝外伤35 例中治愈30 例，治愈率85.7% ;死亡5 例，病死率 14.3% ，其中术中死亡3 例，术后 死亡2 例;术后并发症 13 例，发生率为 37.1% ，其中并发术后脯下感染3 例，术后肝版肿 2 例，术后再出血 3 例，术后胆瘦3 例，术后应激性溃殇出血 1 例，切口感染 l 例，均经保守治疗后痊愈。结论 本组严重外 伤性肝破裂病例的主要死亡原因为严重合并伤、严重失血性休克。选择合适的手术方式，同时积极地处理 合并伤，术中精确止血，预防肝脏继发性出血及胆瘦，建立通畅的外引流，是救治严重肝破裂的关键。 [关键词] 肝破裂; 手术方式; 肝切除; 并发症 [中图分类号] R 657.3 [文献标识码] A Operation methods treating severe traumatic hepatic rupture L如lunsheng. Department of Second General Surgery , Beijing Shunyi Hospital , Beijing 101300 , China , Email: frank_lee1996@163.com [Abstract] Objective To investigate the individualized operation methods treating severe traumatic hepat- ic rupture. Methods Totally 35 cases who suffered from severe traumatic hepatic rupture were enrolled. The number of closed injury was 32 and open injury was 3. The number of traffic accident injury was 21 and high fall- ing injury was 5. The blunt force injury was 5 and the abdominal stab wound was 4. Results The 35 patients sus- pected of the traumatic hepatic rupture by abdominal B scan had diagnostic abdominal puncture examination before operation , and they were diagnosed with abdominallaparotomy. Among the 35 cases , 30(85.7%) were cured and 5 cases( 14. 3%) died. 3 cases died in operation and 2 cases died after operation. There were 13 cases( 37. 1 % ) having complication after operation. The number of the subphrenic infection was 3; the liver abscess was 2; the re- bleeding wás 3; the biliary fistula was 3; the stress ulcer