90例肝外伤手术预后临床分析.docVIP

90例肝外伤手术预后的临床分析 　　【摘要】 目的 分析影响肝外伤手术预后的危险因素。方法 回顾性分析90例肝外伤手术治疗病例,对影响手术死亡率的危险因素进行单因素比较。结果 总体的手术死亡14例(16%),Ⅲ级1例,Ⅳ级4例,Ⅴ级9例;与肝脏相关的死因11例(12%),与肝脏无关的死因3例(3%)。ⅣⅤ级中死亡组和生存组的单因素比较提示:收缩压、脉搏、术中总失血量、住院天数,这5项指标两组间的差异明显。重度肝外伤手术方式的单因素比较提示:清创性肝切除术的相对危险度(HR)是0.73,手术死亡率相对较低;而规则性肝切除术、肝静脉或肝后下腔静脉修补术HR分别是1.32、1.52,手术死亡率相对较高。 结论 早期复苏、合理的手术方式和减少术中出血量将有助于降低手术死亡率。 　　【关键词】 　　肝外伤;外科治疗;手术死亡率 　　 　　The analysis about the clinical prognosis of 90 patients with blunt hepatic injuries after surgieal management 　　 　　 　　【Abstract】 Objective To analysis the risk factors determining operative mortality in blunt hepatic injuries.Methods This was a retrospective case study of90 patients with blunt hepatic injuries managed operatively.Statistical analysis was performed using univariate analysis logistic regression.Results The overall operative mortality was 16%,and 14 patients died with 1 in grade Ⅲ,4 in grade Ⅳ,9 in grade Ⅴand 11 cases in liver related cause(12%) and 3 in not liver related cause(3%).Univariate comparison of clinical factors between nonsurvivors and survivors in grade ⅣⅤ indicated:systolic blood pressure,pulse,injury severity sore(ISS),total intraoperative blood loss and hospital days were significant between two groups.Comparison of surgical treatment of severe hepatic injuries indicated:relative hazard ratio(HR)of debridement hepatectomy was 0.73,and the operative mortality was low.HR of anatomical hepatectomy and venorrhaphy of major hepatic vein and retrohepatic vena cava were 1.32 and 1.52 respectively,and the operative mortality was high.Conclusion Expeditious resuscitation and appropriate surgical management,to control operative blood loss,are helpful to reduce operative mortality in patients with blunt hepatic trauma. 　　【Key words】 　　Blunt hepatic injuries; Surgical management; Operative mortality 　　 　　DOI:10.3760/cma.j.issn2010.01.46 　　作者单位:526021广???省肇庆市第一人民医院 　　 　　肝外伤病情复杂,合并伤多,总死亡率在10%左右?[1]?,而严重肝外伤常合并肝周大静脉损伤,死亡率高达50%以上?[2]?,手术无固定的模式,术中出血仍是主要死亡原因之一。本研究回顾性