CAJ | 학술논문

目的：总结儿童闭合性肝外伤手术患儿诊疗经验。方法回顾分析2000.9-2014.10间我院21例手术治疗的闭合性肝外伤儿童临床资料，其中男10例，女11例，年龄11月~12岁5月，平均5.2岁，致伤原因以车祸伤为主，术中见3例肝包膜下血肿，16例肝脏裂伤，1例损及第二肝门，1例损及第三肝门，术中以3.0~5.0 Prolenen缝合创面，单纯修补10例，可吸收止血材料填塞2例，填塞加缝合7例，肝静脉修补1例，下腔静脉及肝短静脉修补1例。结果17例患儿经手术止血，获得痊愈，2例患儿术后出现胆漏，其中外引流1例，胆肠吻合1例，最终痊愈出院。1例术前由于脑缺氧缺血时间过长，术后出现脑部并发症，1例因肝外伤损伤肝静脉，术后出现肝功能衰竭死亡。结论儿童闭合性肝外伤应积极恢复血流动力学，血流动力学不稳者行手术探查，术中应以修补或可吸收止血材料填塞为主，避免切除具有活性的肝脏组织，严格仔细止血、良好的手术技巧及方式的选择、恰当的辅助治疗措施均是避免术后再次出血和获得痊愈的重要影响因素。
목적：총결인동폐합성간외상수술환인진료경험。방법회고분석2000.9-2014.10간아원21례수술치료적폐합성간외상인동림상자료，기중남10례，녀11례，년령11월~12세5월，평균5.2세，치상원인이차화상위주，술중견3례간포막하혈종，16례간장렬상，1례손급제이간문，1례손급제삼간문，술중이3.0~5.0 Prolenen봉합창면，단순수보10례，가흡수지혈재료전새2례，전새가봉합7례，간정맥수보1례，하강정맥급간단정맥수보1례。결과17례환인경수술지혈，획득전유，2례환인술후출현담루，기중외인류1례，담장문합1례，최종전유출원。1례술전유우뇌결양결혈시간과장，술후출현뇌부병발증，1례인간외상손상간정맥，술후출현간공능쇠갈사망。결론인동폐합성간외상응적겁회복혈류동역학，혈류동역학불은자행수술탐사，술중응이수보혹가흡수지혈재료전새위주，피면절제구유활성적간장조직，엄격자세지혈、량호적수술기교급방식적선택、흡당적보조치료조시균시피면술후재차출혈화획득전유적중요영향인소。
Objective To summarize clinical procedure of 21 children undergoing hepatic trauma who accepted surgery treatment and analyze the influencing factors. Methods 21 children who suffered from traumatic hepatic rupture and treated in our hosipital from September 2000 to October 2014were enrolled.Clinical data has been retrospectively analyzed and treatment measures are summarized. This group is including 10 males and 11 females, with their ages ranging from 11 months to 149 months and a mean age is 5.2 years. And the main cause of trauma was due to traffic accident. three cases had hepatic subcapsular hematoma. sixteen cases had liver laceration injury. one case had second porta hepatic injury. one case had the third porta hepatic injury.and 3.0 ~ 5.0 Prolenen had been used intraoperatively to suture wounds. ten cases were vsimple repaired, two cases were filled with absorbable hemostasis materials. seven cases had been treated through tamponade and suture. Hepatic vein in one case had been repaired,and one case was repaired short hepatic vein and inferior vena cava. Results 21 cases was treated by surgical treatment and aimed to stop bleeding. In the end ,seventeen cases had been cured without complication. one case happened postoperative brain death because of ischemia time was too long. one case died of the damage of liver blood vessels. two cases had bile leakage after operation.one case took external drainage, and another one accepted choledochojejunostomy. Conclusion Hepatic trauma is severe to children. Treatment should be positive and at the same time blood flow dynamics should be restored.Surgical treatment also should be chosen as soon as possible. liver should be repaired or filled with absorbable hemostasis material not but cut the active liver tissue. Strict intraoperatie bleeding, good surgical skills, and the appropriate auxiliary treatment would be useful to avoid postoperative bleeding again.