中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
5期
677-679
,共3页
肝破裂%手术方式%肝切除%并发症
肝破裂%手術方式%肝切除%併髮癥
간파렬%수술방식%간절제%병발증
Hepatic rupture%Operation method%Hepatectomy%Complication
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％,其中并发术后膈下感染3例,术后肝脓肿2例,术后再出血3例,术后胆瘘3例,术后应激性溃疡出血l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瘘,建立通畅的外引流,是救治严重肝破裂的关键.
目的 探討嚴重外傷性肝破裂的箇體化手術方式.方法 迴顧分析1999年9月至2013年9月北京市順義區醫院與佳木斯大學第一附屬醫院收治的35例嚴重肝外傷患者的臨床資料,其中閉閤性損傷32例,開放性損傷3例.其中車禍傷21例,高處墜落傷5例,鈍物傷5例,刀刺傷4例.35例均閤併其他髒器損傷.結果 35例患者術前經腹部B型超聲、診斷性腹腔穿刺檢查疑診為肝破裂,均經剖腹探查確診.嚴重肝外傷35例中治愈30例,治愈率85.7％;死亡5例,病死率14.3％,其中術中死亡3例,術後死亡2例;術後併髮癥13例,髮生率為37.1％,其中併髮術後膈下感染3例,術後肝膿腫2例,術後再齣血3例,術後膽瘺3例,術後應激性潰瘍齣血l例,切口感染l例,均經保守治療後痊愈.結論 本組嚴重外傷性肝破裂病例的主要死亡原因為嚴重閤併傷、嚴重失血性休剋.選擇閤適的手術方式,同時積極地處理閤併傷,術中精確止血,預防肝髒繼髮性齣血及膽瘺,建立通暢的外引流,是救治嚴重肝破裂的關鍵.
목적 탐토엄중외상성간파렬적개체화수술방식.방법 회고분석1999년9월지2013년9월북경시순의구의원여가목사대학제일부속의원수치적35례엄중간외상환자적림상자료,기중폐합성손상32례,개방성손상3례.기중차화상21례,고처추락상5례,둔물상5례,도자상4례.35례균합병기타장기손상.결과 35례환자술전경복부B형초성、진단성복강천자검사의진위간파렬,균경부복탐사학진.엄중간외상35례중치유30례,치유솔85.7％;사망5례,병사솔14.3％,기중술중사망3례,술후사망2례;술후병발증13례,발생솔위37.1％,기중병발술후격하감염3례,술후간농종2례,술후재출혈3례,술후담루3례,술후응격성궤양출혈l례,절구감염l례,균경보수치료후전유.결론 본조엄중외상성간파렬병례적주요사망원인위엄중합병상、엄중실혈성휴극.선택합괄적수술방식,동시적겁지처리합병상,술중정학지혈,예방간장계발성출혈급담루,건립통창적외인류,시구치엄중간파렬적관건.
Objective To investigate the individualized operation methods treating severe traumatic hepatic 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 falling injury was 5.The blunt force injury was 5 and the abdominal stab wound was 4.Results The 35 patients suspected of the traumatic hepatic rupture by abdominal B scan had diagnostic abdominal puncture examination before operation,and they were diagnosed with abdominal laparotomy.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 rebleeding was 3 ; the biliary fistula was 3 ; the stress ulcer bleeding was 1 and the surgical wound infection was 1.They were cured by conservative treatment.Conclusions Main death causes include the severe associated injuries and the severe hemorrhagic shock.The proper operative method is the key treatment of the severe traumatic hepatic rapture; meanwhile we should deal with the associated injuries,etc.
