肝损伤外科治疗的分级处理

                            本文发表于肝胆外科杂志2001，9（5）
【摘要】 目的 探讨肝损伤外科治疗的分级处理方法。方法 总结近年来84例肝损伤治疗情况。其中,Ⅰ级12例,Ⅱ级26例,Ⅲ级32例,Ⅳ级6例,Ⅴ级8例。非手术治疗18例(占总数的22.6%);手术治疗65例,单纯肝组织缝补42例,不规则性、清创性肝切除21例,碘仿纱条填塞2例。结果 临床痊愈75例,无手术并发症发生。死亡7例,总病死率8.33%,分级病死率:Ⅰ~Ⅱ级0%,Ⅲ级6.25%(2/32),Ⅳ级0%,Ⅴ级62.5%（5/8)。结论 肝损伤应实行分级的外科限时处理,Ⅲ级以下损伤可适当保守治疗,Ⅲ级或其以上损伤应强化抗休克措施,依据损伤类型进行相应的手术治疗,以彻底清创止血,合理引流,广东省中山市人民医院肝胆外科周载平
防治并发症。
【关键词】 肝损伤;分级;治疗
【中图分类号】 R657.3   【文献标识码】 A  
【文章编号】 1006-4761(2001)05-0333-02
SURGERY MANAGEMENT OF DIFFERENT LIVER INJURY(84CASES REPORT)
Zhou Zaiping,Hu Ze min,Yu Yuanlong,et al.
 Zhongshan City People"s Hospital,Guangdong Province,Zhong shan,528403
【Abstract】 Objective  To explore surgical management for different hepatic injury.Methods  The data of 84 cases with hepatic injury in our hospital were summarized.Among these,GradeⅠwere found in 12  cases,GradeⅡin 26,GradeⅢ in 32,GradeⅣin 6,and gradeⅤin 8.Non_ operation therapy were performed in 18 cases,operation in 65,merely liver tissue mended in 42,non_ regular and debrided hepatectomy in 21,iodoform yarn strip packed in 2.Results  75 cases recovered clinically without complications.7 cases died(8.33%).The mortality in gradeⅠ~Ⅱwas 0%,GradeⅢ6.25%(3/32),Grade Ⅳ0%,and GradeⅤ62.5%(5/8).Conclusion  Graded surgical management in limited time should be performed in hepatic injury.Injury under GradeⅢshould be appropriately performed conservative   therapy,antishock management should be reinforced in injury under GradeⅢ,operation should be carried out according to the type of injury,to keep through debridement and stop bleeding,reasonable drainage,and prevent complication.
【Key words】  Liver injury;   Scoring;   Treatment
   现代交通体系和社会治安的复杂使肝损伤的病例日益增多,复合伤和重度肝损伤的病死率居高不下[1]。国际通行的脏器损伤分级利于创伤救治程式的标准化和治疗方案的分级管理,从而有效地提高抢救成功率。本文总结近年84例肝损伤治疗情况,探讨外科治疗的分级管理问题。
1 临床材料
1.1 一般资料
1994年1月~2000年9月本院收治肝损伤84例,男61例,女23例,年龄3~78岁,平均年龄29.6岁。损伤原因:刀器伤16例,车祸伤43例,坠落伤11例,其他钝物击伤14例,其中开放性损伤18例,闭合性损伤66例。
................