鈍性肝臟創傷之外科治療

Surgical Management of Blunt Liver Trauma

吳九龍(Chiu-Lung Wu)

《The Kaohsiung Journal of Medical Sciences》 8卷7期 (1992/07) Pp. 384-389

https://doi.org/10.6452/KJMS.199207.0384

摘要

1986年至1990年，五年間共有46鈍性肝臟創傷患者，在本院外科部接受手術治療，其中男性33例，女性13例，年齡分布2歲至62歲，平均31歲，追蹤期間由16個月至73個月，平均43個月。肝創傷嚴動度依美國創傷外科醫學會提出肝臟創傷標準度(liver injury scale)分為六級，第一級4例，第二級18例，第三級16例，第四級2例，第五級4例，第六級2例。外科手術方式4例僅作引流，4例單純縫合，27例縫合及引流，3例清創並結紮血管，4例作部份肝切除，3例接受下腔靜脈修補術，1例用紗布填塞。7例死亡，死亡率為15.2％。14例發生併發症，其中肺部感染2例，傷口感染4例，腹內膿瘍3例，腸阻塞2例，胰臟炎3例，併發症發生率為30.3％

並列摘要

From 1986 to 1990, 46 patients with blunt liver trauma were hospitalized and operated on in Kuang Tien General Hospital. Includedf were 33 males and 13 femalis with a mean age of 31 years (range: 2 to 62). the mean dura-tion of the follow-up was 43 months. Weclassified the severity of liver injury with the liver injury scale which was published by the Oragan injury scaling (O. I. S.) Com-mittee of the American Association for the Surgery of Trauma (A. A. S. T.) in 1989. Ac-cording to the operative findings, the liver in-jury of the 46 cases were classified as follows: grade I 4 cases, grade II 18 cases, grade III 16 cases, grade IV 2 cases, grade V 4 cases, and grade VI 2 cases. Among the patients, 4 cases were treated with drainage. Four cases underwent simple re-pair. Twenty-seven cases were treated with re-pair and drainage. Three cases underwent de-bridement and selective ligation of bleeding vessels. Four cases underwent partial resection of liver, and 3 cases required reapair of the in-ferior vena cava. One case was packed with gauze for hemostasis. The mortality rate was 15.2%, and the morbidity rate 30.3% . The most frequent postoperative complications related to the hepatic injury in the patients who survived the initial operation were wound infection (8.7%), intra-abdominal abscesses (6.5%), pancreatitis(6.5%),pulmonary infection (4.3%),and small bowel obstruction(4.3%).

並列關鍵字

blunt liver trauma ； liver injury scale ； abdominal trauma