儿童闭合性肝脏外伤的诊治体会

Diagnosis and treatment for blunt hepatic trauma in children

摘要:

目的：探讨儿童闭合性肝脏外伤的诊断及治疗方法。方法：回顾分析本中心6年来收治儿童闭合性肝脏外伤共32例。创伤原因包括车祸伤11例，跌伤9例，钝物挤压及击打伤7例，高处坠落伤5例。根据1989年美国创伤外科学会的分级法，Ⅰ级19例（60%）、Ⅱ级9例（28%）、Ⅲ级3例（9%）、Ⅳ级1例（3%）。28例行保守治疗，4例行手术治疗。结果：28例行保守治疗后痊愈，4例手术治疗行肝脏裂伤修补术，1例术后再次出血手术，皆痊愈出院。结论：儿童闭合性肝脏外伤多数在严密监护及积极保守治疗下均可获得满意的疗效。如何根据儿童生命体征变化及B超、CT等资料判断是否及时中转手术是治疗儿童肝脏外伤的关键，即使并无明显腹腔积血等，如CT提示肝脏裂伤程度较重，也应积极行手术修补裂伤。

Abstract:

Objective：To explore the most effective diagnosis and treatment methods for blunt hepatic trauma in children. Methods：Totally 32 children with blunt hepatic trauma were analyzed retrospectively in our center. Trauma causes included traffic accident in 11 cases，tumbling injury in 9 cases，blunt extrusion and blow injury in 7 cases，falling injury in 5 cases. All traumas were classified as grade Ⅰof 19 cases，gradeⅡ of 9 cases，gradeⅢ of 3 cases and grade Ⅳ of 1 case according to the grading method in American So－ciety of Trauma Surgery（AAST） in 1989. Results：Twenty-eight cases were cured after conservative treatment. Four children under－went liver laceration repair and 1 child underwent operation again due to re-bleeding. All children were well recovered. Conclusion：Most children with blunt hepatic trauma could be cured with conservative treatment under the condition of intensive care. The most important point is how to make the critical decision of operation according to ultrasound and computed tomography. Even if there is no significant hemoperitoneum，if the CT indicates severe laceration of the liver，surgical repair should actively performed.