严重肝外伤67例手术治疗分析.pdfVIP

中华损伤与修复杂志(电子版)别7 年第2 卷第 1 期 αúnJ I$ry协调r aO:I阳:n:I~(Fl耐mic V，棚oo) .Fi制lIIIY 2007. Vo12. N队 1 • 33 • ·论著· 严重肝外伤67 例子术治疗分析 草谦五力斌李洪李君九唐世龙熊秋华欧阳杰 {摘要] 目的搬讨严戴肝外伤(皿阳 V级)的治疗方法。方法 回顾性分析采取不同的手术 方法治疗67 例严囊肝外伤患者的临床资料。其中班级30 例，lV级 28 例， V级9 例;采用修补、不规 则叶切除术或肝叶切除术。结果 金组 67 例均于急谚科床边启超检查确谐。本坦手术棋救率为 85.7% ，死亡率为 14.9% ，并发胸腔积液率为 13.4% ，肺部感染率为9.0%0 主要死亡原因:合并肝厨 下腔静脉损伤术中出血休克死亡率为8.6% ，骨盆骨忻、颅脑损伤和ARDS 均为1. 5% 。结论 床边B 超对严熏肝损伤的谤断是一种方便而快捷的方法。提高严意肝外伤拍愈率和降低死亡率的走要措蹄 是立即建立探静脉穿刺扩睿扰休克复苏处理和紧急配血‘输血同时将病人直接转入手术室立即乎术 拍疗及选择合理的手术方式。 [关键词} 肝外伤;出血;手术 Treatment of severe hepatic i时ury: report of 67 cases TAN Qωn ， 职4NG μbing ， U Hong , et α1. Departmerú 01 Surge厅， Donghua Hospital , Dongguan 523110 , China [ Abstract] Objective To evalu耐 the treatment of severe hepatic traumatic injuη(grade m 呻 v). Methods The clinical data of 67 patients with severe hepatic traumatic ìnjury who underwent opera嗣 tion in our hospiωwere retrospectively analyzed. According to hepatic injury grading , 30 cases were grade m, 28 cωes were grade IV and 9 cases 副伊ooe V. Result All cases were conclusíve dia伊losed by the bedside type B- Ultrasonography ín emergency d叩artment.切le cure rate was 85.7% and the mortality was 14.9%. The morbidity of thoracic hydrop8 was 13.4% and that of pulmona巧 infection w脑 9.0%. 币le major lethal causes were intraope刚ive hemoηhagic shock with the injury of posthepatíc inferior 阴阳 cava (IVC).. (8. 6% ) , pelvic fracture( 1. 5% ) t craniocerebral i时ury ( 1. 5%) and ARDS ( 1. 5% ). Conclusion The bedside type B-ultrason。伊叩hy wωan 似pediently and quick meωure for the diagnosis of severe hepatic in- jury. The optímal fescuing of hepatic ínjury included: the ímmediate establishment of the catheterization in deep veins for fast and effectíve fluid resuscitation for the management of hypovolemic shock t emergent blω