中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (08): 656-659.

• 专题笔谈 • 上一篇    下一篇

复杂肝外伤的手术治疗

王    东,朱继业   

  1. 北京大学人民医院  北京大学器官移植中心,北京100044
  • 出版日期:2010-08-01 发布日期:2010-08-02

  • Online:2010-08-01 Published:2010-08-02

摘要:

复杂肝外伤是指大面积的肝实质损伤或同时合并有重要血管的损伤,病死率高且治疗困难,目前非手术治疗在其治疗中所占比例越来越高,但对持续存在血流动力学不稳定或合并其他脏器损伤者应积极手术干预。接受手术的多数病人可采用清创性肝切除、血管修补、带蒂大网膜填塞等方法来控制出血,而对少数极危重病人如合并低体温、代谢性酸中毒和凝血功能障碍者,应采取损伤控制手术和血管介入技术以提高救治成功率。

Abstract:

Operative management for complex hepatic injuries  WANG Dong, ZHU Ji-ye. Department of Hepatobiliary Surgery,Peking University People’s Hospital,Beijing100044,China.
Corresponding author: ZHU Ji-ye, E-mail: gandanwk@vip.sina.com
Abstract    Complex liver injuries are severe damages of liver parenchyma with or without rupture of important blood vessels. The mortality of complex liver injuries is high and it is hard to treat. Non-operative management (NOM) of hemodynamically stable patients has become the standard of care, while operation should be applied to those hemodynamically unstable patients and other organs involved. Irregular hepatectomy, direct repair of vessels, perihepatic packing are common blood control methods, while damage control surgery (DCS) is recommended in those with hypothermia, metabolic acidosis and coagulation disorders. Reduction of mortality might be found if combination therapy of hepatic arterial embolization and DCS was applied to them.