【摘要】 目的探讨肝外伤非手术治疗的适应证、治疗措施和效果。方法回顾性分析采用非手术治疗49例肝外伤患者资料,其中按美国创伤外科协会分级标准Ⅰ级26例,Ⅱ级19例,Ⅲ级3例,Ⅳ级1例。结果 49例全部治愈,其中非手术治愈46例,占93.88%,包括介入治疗5例(肝动脉栓塞治疗3例,穿刺置管引流2例);中转手术3例,占6.12%,为血肿破裂引起大出血。并发症4例,肝脓肿1例,穿刺置管引流治愈;胸腔积液2例,1例经胸腔穿刺后治愈,1例自行吸收;胆瘘1例,穿刺置管引流治愈。结论对Ⅰ、Ⅱ级及部分Ⅲ级肝外伤患者行非手术治疗安全、可行,血流动力学稳定是治疗的基础,严格掌握适应证是治疗的关键。更多还原

【Abstract】 Objective To explore the indications,treatment measures and effects of surgical therapy in hepatic trauma.Methods The clinical data of 49 patients with hepatic trauma treated by non-operative therapies were retrospectively analyzed.Among them,there were 26 cases of AAST grade I,19 cases of grade Ⅱ,3 cases of grade Ⅲ and 1 case of grade Ⅳ.Results All 49 cases were cured.46 cases were cured by non-operative treatment(93.88%),including 5 cases of interventional therapy(3 cases of hepatic arterial embolism and 2 cases of percutaneous catheter drainage).3 cases of massive bleeding caused by hematoma rupturing were converted to operation,accounting for 6.12%.The complications were in 4 cases.1 case of liver abscess was cured by percutaneous catheter drainage.In 2 cases of pleural effusion,1 case was cured after thoracocentesis and another case was voluntarily absorbed.1 case of biliary fistula was cured by percutaneous catheter drainage.Conclusion For grade I,grade Ⅱ and partial grade Ⅲ hepatic trauma,non-operative treatment is safe and feasible.Stable hemodynamics of the patients should be the basis of treatment.The key point of treatment is to strictly master the indications.更多还原