Urman M G, Subbotin A V
Vestn Khir Im I I Grek. 2009;168(3):72-5.
The authors have analyzed results of treatment of 641 patients with the liver injury: blunt injury--209, penetrating--432. Surgical strategy depends on the condition of the patient on admission, severity of the liver injury and combined trauma. Suturing the rupture (wound) of the liver was the method of choice in the I-II degrees of the liver injury. If it was impossible to achieve hemostasis in the bottom of the wound in the III-IV degrees of the liver injury, package with gauze drain (7) and ligation of the hepatic artery (3) were used. Resection of the liver was performed in 22 patients. In the postoperative period the main complications were: peritonitis (22), subphrenic abscesses (13), hemobilia (7), subhepatic abscesses (6) and liver abscesses (5). Embolization of the hepatic artery branches was preferable in hemobilia. The mortality rate in blunt injuries of the liver was 28.2%, gunshot wounds--27.6% and knife injury--4%.
作者分析了641例肝损伤患者的治疗结果:钝性损伤209例,穿透性损伤432例。手术策略取决于患者入院时的状况、肝损伤的严重程度以及合并伤情况。对于Ⅰ-Ⅱ度肝损伤,肝破裂(伤口)缝合是首选方法。如果在Ⅲ-Ⅳ度肝损伤的伤口底部无法实现止血,则采用纱布引流包裹(7例)和肝动脉结扎(3例)。22例患者进行了肝切除术。术后主要并发症有:腹膜炎(22例)、膈下脓肿(13例)、胆道出血(7例)、肝下脓肿(6例)和肝脓肿(5例)。对于胆道出血,肝动脉分支栓塞术较为可取。肝钝性损伤的死亡率为28.2%,枪伤为27.6%,刀伤为4%。