Solheim K, Buanes T, Gerner T, Høivik B
Kirurgisk klinikk Ullevål sykehus, Oslo.
Tidsskr Nor Laegeforen. 1996 Mar 20;116(8):948-51.
We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.
我们报告了1983年至1994年期间在我们的第一创伤中心治疗的193例创伤性肝损伤患者；即每年约13例患者。该中心的服务人口为85万。大多数患者伤势严重，在151例多发伤患者中，每位患者平均有3.2个受伤器官。临床诊断工作辅以腹腔灌洗、超声检查和计算机断层扫描。38例患者未接受手术，其中25例存活。125例患者采用了剖腹探查术，术中或行肝缝合或不行肝缝合，18例重伤患者行肝切除术，死亡率超过50%。12例患者采用了肝周填塞法，所有这些患者均合并其他严重损伤，且因这些损伤导致的死亡率较高。肝损伤可分为两组。少数受伤患者在严重休克状态下入院，可能需立即行开胸手术并钳夹主动脉，随后紧急剖腹手术，通过填塞控制出血。快速检查腹部其余部位并关闭腹腔，以避免出血和多次输血引起的众所周知的并发症，即低氧血症、酸中毒和体温过低。2至3天后再次剖腹手术取出填塞物。病情稳定的患者应接受计算机断层扫描检查，可能无需手术治疗，但必须密切进行临床随访。
