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1、手术治疗严重肝外伤36例体会［摘要］目的：探讨严重肝外伤的手术方式和治疗效果。方法：回顾性分析1993年5月〜2006年5月我院手术治疗的严重肝外伤患者36例，AASTIII级者仃例，IV级者14例，V级者5例。结果：采用肝破裂清创缝合止血15例，清创加带蒂大网膜、明胶海绵填塞缝合9例，清创性肝切除7例，纱布填塞3例，肝后下腔静脉、肝静脉主干缝合修补2例。手术治愈29例，治愈率为80.56%,死亡7例，死亡率为19.44%,死于多器官功能障碍综合征（MODS）3例、败血症1例、失血性休克1例、继发性出血2例。术后出现并发症“例
2、（发生率为30.56%），其中，并发膈下感染4例，肝脓肿2例，胆痿1例，再出血2例，MODS2例。结论：手术是治疗严重肝外伤的有效方法，手术方式应根据具体情况合理选择，加强对合并伤及术后并发症的管理对降低严重肝外伤的死亡率具有重要意义。［关键词］肝脏；创伤和损伤；手术［中图分类号］R657.3［文献标识码］C［文章编^■］1673-7210(2008)05(c)-180-02Experieneeofoperativetreatmentfor36casesofpatientswithseverelivertraumaWANGYa
3、ng,LIHong,DUBing-li(DepartmentofPathology,theFirstHospitalofHuairouDistrict,Beijing101400,China)[Abstract]Objective:Toexplorethemethodsofoperationandtheeffectsoftreatmentforseverelivertrauma.Methods:36casesofpatientswithseverelivertraumawithoperativetreatmantinourho
4、spitalfromMay1993toMay2006werestudiedretrospectively.AccordingtotheAASTGradingofLiverInjuries,17casesofgrade111,14casesofgradeIVand5casesofgradeV.Results:Differentoperationswereperformedasfollowing:debridementsutureofhepatorrhexisin15cases,debridementwithgreateromen
5、tumorgelatinspongepackingin9cases,resectionaldebridementin7cases,gauzespackingin3cases,sutureofinferiorvenacavainposteriorsegmentofliverandhepaticveinstemin2cases.29caseswerecured(cureratewas80.56%),7casesdied(mortalitywas19.44%).Thecausesofdeathweremultipleorgandys
6、functionsyndrome(MODS)in3cases,septemiain1case,hemorrhagicshockin1caseandsecondarybleedingafteroperationin3cases.Postoperativecomplicationswere11cases(incidenceratewas30.56%),including4casesofsubphrenicinfection,2casesofliverabscess,1caseofbiliaryfistula,2casesofreh
7、eamorrhagiaand2casesofMODS・Conclusion:Operationistheeffectivetreatmentforseverelivertrauma.Themethodsofoperationshouldbechoosedcorrectlyaccordingtothespecificconditions」tissignificantforreducingthemortalityofseverelivertraumatostrengthenthemanagementofassociatedinju
8、ryandpostoperativecomplications.[Keywords]Liver;Woundsandinjuries;Operation肝外伤是外科常见的创伤性急腹症，近年来其治疗虽已取得重大进展，但严重肝外伤仍因伤情复杂、病情危重且易合并多脏器损伤而导致手术处
