严重肝外伤23例手术术式探讨

    Exploration of the appropriate operative method for severe hepatic trauma: a report of 23 cases

    • 摘要: 目的:探讨严重肝外伤手术和再手术术式选择及治疗效果。方法:对23例严重肝外伤患者行肝清创后缝合修补2例,大网膜填塞修补9例,一期清创性肝切除8例(其中1例同时行肝周纱布填塞),单纯行肝周纱布填塞4例(其中2例二期行清创性肝切除);同时行脾切除3例,胃修补1例。结果:23例中,肝外伤Ⅲ级13例,Ⅳ级8例,Ⅴ级2例。21例治愈,未发生严重并发症。2例死亡。结论:手术是治疗严重肝外伤的有效方法。应根据患者的局部和全身情况,选择合理术式。条件允许时,清创性肝切除术是最有效和并发症最少的手术方法。

       

      Abstract: Objective: To explore the appropriate operative/re-operative methods and evaluate the outcomes of severe hepatic trauma.Methods: Among the 23 patients suffered from severe hepatic trauma,two patients accepted suture repair after debridement,9 patients accepted plugging repair by great omentum,8 by hepatectomy (one also treated with ribbon gauze plugging around the liver),and the other four accepted ribbon gauze plugging around the liver (two of the patients underwent secondary hepatectomy).Splenectomy was carried out for 3 patients and gastrorrhaphy was carried out for 1 patient.Results: Among the 23 patients,the hepatic trauma was graded as Ⅲ for 13 cases,Ⅳ for 8 cases,and Ⅴ for 2 cases,respectively.Twenty one patients were cured without accompanying with any complications.Two patients died.Conclusions: Operation is an effective treatment for severe hepatic trauma.The choice of operative method depends on the situation of the patient.If the surgery condition is appropriate,the hepatectomy could be the best choice for severe hepatic trauma due to the efficacy and minimum complications.

       

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