外伤性肝破裂的早期诊断和治疗
安东均 王旗 张成
摘要
目的：探讨外伤性肝破裂的早期诊断、抢救治疗的经验和教训。
方法：回顾性分析我院收治的240例外伤性肝破裂的临床资料。
结果：本组中车祸伤108例，刀刺伤56例，坠伤40例，其他36例。单纯肝破裂122例，合并其他脏器损伤者118例。腹腔穿刺、B超和CT检查的诊断阳性率分别为92.3%、93.8%和93.6%。入院时休克216例。术中发现腔内积血300～3500mL平均1350mL肝修补150例，肝部分切除66例，保守治疗24例。全组治愈率93.3%（224/240）
结论：早期诊断是及时救治外伤性肝破裂的首要环节。出血性休克是外伤性肝破裂致死的主要原因，抢救的重点在于纠正出血性休克。严重肝损伤应当机立断进行手术治疗，根据伤情选择单纯肝修补、肝修补加吸收性明胶海绵或大网膜填塞和肝脏部分切除，止血不满意还需加做选择性肝动脉结扎术。
关键词
外伤；肝破裂；手术方式；治疗
Early Diagnosis and Treatment of Traumatic Hepatic Rupture
AN Dongjun，WANG Qi，ZHANG Cheng.Department of Hepatobiliary Surgery，the Cen ter Hospital of Xianyang City，Xianyang，712000，China.
Corresponding author:AN Dongjun Email:1158011981@qq.com
ABSTRACT
Objective:To explore the experiences and lessons of early diagnosis and emergency treatment of traumatic liver rupture.
Methods:The clinical data of 240 cases of traumatic liver rupture admitted to our hospital were analyzed retrospectively.
Results:In this group，there were 108 cases of traffic accident injuries，28 cases of stab wounds，40 cases of falling injuries and 18 cases of other injuries.122 cases were simple liver rupture and 118 cases were complicated with other organ injuries.The diagnostic positive rates of abdominal puncture，B-ultrasound and CT were 92.3% ，93.8%and 93.6%respectively.Shock on admission 108 cases.Intraluminal hematocele was found in 75 cases with an average of 130ml of 130 ml liver repair，33 cases with partial hepatectomy and 12 cases with conservative treatment.The cure rate was 93.3%（224/240）.
Conclusion:Early diagnosis is the primary link for timely treatment of traumatic liver rupture.Hemorrhagic shock is the main cause of death due to traumatic liver rupture.The key point of rescue is to correct hemorrhagic shock.Severe liver injury should be treated by surgery immediately.According to the injury，simple liver repair，liver repair plus gelatin sponge or omentum tamponade and partial liver resection should be selected.If hemostasis is not satisfactory，selective hepatic artery ligation should be added.
KEY WORDS
Trauma；Liver rupture；Surgical methods；Treatment
肝脏是人体最大的实质性脏器。且质脆而易受损伤。肝损伤在腹部外伤中占15%～20%［1］。常伴有严重的出血性休克、胆汁性腹膜炎和继发感染，如果处理不及时，后果严重，危及生命。我院自1993年1月～2002年6月。共收治外伤性肝破裂240例。现就其诊断与治疗体会分析如下。