王松平，袁中旭，刘书先，梁　山，许榕生，吴文周，李建生

·胆破裂·

84例外伤性肝破裂诊疗经验分析

王松平，袁中旭，刘书先，梁山，许榕生，吴文周，李建生

目的总结外伤性肝破裂的诊治经验。方法回顾性分析2005年6月至2015年6月我科收治的外伤性肝破裂患者的临床资料。结果在84例患者中，男55例，女29例，年龄16～66岁,平均年龄（35±5）岁；腹部闭合伤75例，腹部开放性损伤9例；按美国创伤协会分级标准，Ⅰ级24例，Ⅱ级25例，Ⅲ级17例，Ⅳ级10例，Ⅴ级7例，Ⅵ级1例；35例行非手术治疗，均为Ⅰ～Ⅱ级损伤，12例行腹腔镜探查，其中电刀喷凝止血3例，缝合止血4例，术中探查已止血3例，仅行肝周引流，2例中转剖腹；29例行开腹探查；急诊行DSA下经导管动脉内栓塞术治疗10例；非手术治疗35例均治愈，无并发症；开腹手术27例，治愈23例，1例术后二次手术止血，5例并发胆瘘，2例并发肝周脓肿，2例肝内血肿，脓肿及血肿较小，均经穿刺或放置引流管引流后痊愈；开腹手术中死亡1例，死于术中失血性休克难以逆转，1例肝叶切除加肝动脉结扎术，术后因肝功能衰竭死亡，1例右三叶切除术后肝、肾功能衰竭死亡，1例合并严重颅脑损伤死亡。结论外伤性肝破裂的诊断需综合症状、体征、实验室检查、影像学检查等多方面资料，准确快速地进行严重程度分级，再采取不同的治疗方法，可取得满意的效果。

外伤性肝破裂；诊断；治疗

【Abstract】Objective To summarize the diagnosis and treatment of traumatic liver rupture（TLR）. Methods A retrospective analysis of clinical data in 84 patients with traumatic rupture of liver in our hospital. Results Out of 84 patients with TLR included 55 men and 29 women，with the average age of（35±5）yr；75 had abdominal closed injury，and 9 had abdominal open injury，beingⅠclass in 24，Ⅱin 25，Ⅲin 17，Ⅳin 10，Ⅴin 7 and in 1；35 patients received non-operation，12 were treated by laparoscopic exploration，and two of them transferred to operation，29 got abdominal operation and 10 had transcatheter arterial embolization；35 patients recovered with non-surgical treatments without complications，23 patients recovered with abdominal operation，and the complications included bile leakage in 5，liver abscess in 2，liver hematoma in 2；one died of hemorrhagic shock，one died of hepatic failure，one died of renal failure，and one died of craniocerebral injury after abdominal operation.Conclusion The diagnosis of TLR must consider clinical syndromes，signs，laboratory tests，and imaging materials as quickly and accurately as possible，and make a correct severity classification，and take an appropriate approaches.

【Key words】Traumatic liver rupture；Diagnosis；Treatment

随着我国道路交通业的迅猛发展，交通事故频发。作为人体体积最大的脏器，肝脏质地脆弱，在外伤中极易受累。一旦受损，病情复杂，病死率高达20%～50%。……