摘要
目的探讨Ⅲ级或Ⅲ级以上肝损伤患者的综合手术治疗方案及临床疗效。方法对某院收治的68例Ⅲ级或Ⅲ级以上肝损伤患者的临床资料进行回顾性分析,根据美国创伤外科学会(AAST)分级量表分为:Ⅲ级32例,Ⅳ级25例,Ⅴ级11例,68例患者根据肝损伤情况采取不同的手术治疗方式,主要包括:单纯肝缝合术、大网膜填塞联合清创缝合术、清创式肝切除术、肝段切除术、右半肝切除术及肝周纱布填塞术。并对患者手术转归、手术情况及术后并发症进行总结分析。结果治愈60例,约占88.3%;转入上级医院2例,约占2.9%;死亡6例,死亡率为8.8%。手术方法:单纯肝缝合术6例,大网膜填塞联合清创缝合术30例,清创式肝切除术20例,肝段切除术3例,右半肝切除术3例,肝周纱布填塞术6例。术后并发症:切口感染3例,胆漏7例,术后出血8例,肝脓肿7例,下肢深静脉血栓1例,胸腔积液1例。死亡原因:5例因发生多器官功能衰竭,1例发生失血性休克。结论Ⅲ级或Ⅲ级以上肝损伤患者应根据术前超声、CT检查及术中探查情况采取积极合理的手术方式,从而在一定程度上可以提高临床救治率。
Objective To explore comprehensive surgical treatment on patients with liver damage of level Ⅲ orabove and its clinical effect.Methods Clinical data of 68 patients with liver damage of level III or above admitted bya hospital were analyzed retrospectively.In accordance with the scale of AAST, the 68 patients were divided into threecategories, 32 cases of liver damage level Ⅲ, 25 cases of level Ⅳ and 11 cases of level Ⅴ. In accordance with theliver damage level, they were given different surgical treatments, which were liver suture, omental plug combined withdebridement suture, debridement hepatectomy, segmental hepatectomy, right hemihepatectomy and perihepatic gauzepacking.Surgical outcome, operation conditions and postoperative complications were concluded and analyzed.Results60 patients were cured, accounting for about 88.3%.2 cases were transferred toa higher-level hospital, accounting for2.9%.6 cases died, accounting for 8.8%.Surgical methods were also analyzed.30 cases were given liver suture, 30cases omental plug combined with debridement suture, 20 cases debridement hepatectomy, 3 cases segmental hepatec-tomy.3 cases right hemihepatectomy and 6 cases perihepatic gauze packing.Their postoperative complications were al-so analyzed.3 cases were found infection of incision, 7 cases bile leakage, 8 cases postoperative bleeding, 7 cases liv-er abscess, 1 case deep vein thrombosis and 1 case pleural effusion.The reasons of their death were listed in the fol-lowing.5 cases were found multiple organ failure and1 case hemorrhagic shock.Conclusion Patients with liver dam-age level Ⅲ or above should be given proper surgical treatment by combining results of ultrasound and CT examina-tion before operation and intraoperative conditions to improve clinical curative rate toa certain degree.
出处
《中国疗养医学》
2018年第10期1019-1022,共4页
Chinese Journal of Convalescent Medicine
关键词
肝损伤
分级标准
手术方案
临床疗效
Liver damage
Classification standard
Surgical treatment
Clinical effect
