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严重肝外伤的早期右半肝切除术:一例报告

Early right hepatectomy for severe liver trauma: a case report.

作者信息

Guglielmo N, Melandro F, Improta L, Mennini G, Rossi D, Assenza M, Rossi M, Berloco P B

机构信息

Departments "Paride Stefanini", General Surgery and Organ Transplant, Sapienza University of Rome, Italy.

Departments "Pietro Valdoni", Sapienza University of Rome, Italy.

出版信息

Clin Ter. 2015;166(2):e108-10. doi: 10.7417/CT.2015.1830.

Abstract

Liver is frequently involved and injured in blunt abdominal trauma. Although over the last three decades the management of blunt hepatic trauma has gradually shifted toward nonoperative approach whit a significant reduction in overall mortality, surgery remains the main option for hemodinamically unstable patients whit severe liver injuries. A 16-yr-old male in good health suffered a blunt abdominal trauma from a sport accident falling while playing football resulting in a grade V liver injury according to the American Association for the Surgery of Trauma Organ Injury Score. He underwent first to liver packing and next to an early right hepatectomy to arrest the clinical condition impairment In high grade liver injuries, liver resection makes possible to effectively control bleeding, remove necrotic tissue and prevent complications as bile leak. Nevertheless when patient's clinical condition continue to deteriorate despite optimal management a quickly and experienced hands performed hepatectomy may solve the situation.

摘要

肝脏在钝性腹部创伤中常受累及损伤。尽管在过去三十年里,钝性肝外伤的治疗已逐渐转向非手术方法,总体死亡率显著降低,但对于血流动力学不稳定且伴有严重肝损伤的患者,手术仍是主要选择。一名16岁健康男性在踢足球时因运动意外摔倒遭受钝性腹部创伤,根据美国创伤外科协会器官损伤评分,导致V级肝损伤。他首先接受了肝脏填塞,随后进行了早期右半肝切除术以阻止病情恶化。在高级别肝损伤中,肝切除术能够有效控制出血、清除坏死组织并预防诸如胆漏等并发症。然而,尽管进行了最佳治疗,若患者临床状况仍持续恶化,迅速且经验丰富的术者实施肝切除术可能会解决问题。

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