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外傷性肝破裂手術治療121例體會

Hepatectomy for Spontaneous Ｒupture of Ｈepatocellular Ｃarcinoma (Report of 19 Cases)

【摘要】目的探討肝切除術治療原發性肝細胞癌自發性破裂（SRHCC）的效果。方法回顧性分析19例肝切除術治療SRHCC患者的效果。結果肝切除19例，1個月存活率為94.7%，1年、3年及5年存活率分別為63.2%、16.7%及8.3%,平均存活時間為30.8個月(4 d～25年零9個月)，最長1例存活超過25年零9個月，目前仍健在。１８例肝功能屬ChildPugh A級患者安全度過圍手術期；　1例肝功能ChildPugh B級者術后4 d死于肝功能衰竭。結論SRHCC并非均為晚期病變，對早期肝癌破裂肝功能良好者應采取急診手術切肝；　如患者情況或醫療條件不允許，可行延期或二期手術治療。

Clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake

objective To analyze clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake．Methods Clinical data of three patients with late-onset injuries were analyzed retrospectively．Results The first patient was compromised with late-onset traumatic diaphragmatic hernia complicated with shock．The second and third patients were suffered from late—onset traumatic hepatic rupture．After prompt surgery operation，the first and second subjects survived．Unfortunately，the third patient died of severe abdominal infection despite successful operation .Conclusion Late-onset organ injuries must be recognized and treated promptl

外傷性肝脾破裂48例報告

ANALYSIS OF 693 CASES NO TRAUMATIC RUPTURE OF THE LIVER

To comprehend the present situation in diagnosis and treatment of traunatic hepatorrhexis in this country,693 patients with traumatic rupture of the liver in 31 hospitals where to be located in Sichuan,Zhejiang,Guizhou,Yunnan,Fujian,Heilongjiang,Gguangxi and Hebei province in this country were collected through questionnaire and analysed.The data showed that male to female ratio was 4.17 to 1,with an average of 39.3 years.Closed injury accounted for 74.5% and 53.9 percent of them were injured in traffic accident.47.4% of the patients were admitted to the hospital within 4 hours after injury.Hemorrhagic shock was present high up to 61.9%.During exploratory laparotomy,hematoperitoneum was greater than 1000ml accounted for 61.5%,injury to the right lobe of liver 70.0%,and hepatorrexis associated with other organs and tissues injuries were 19.8%.45.5% of the patients was in third degree or more according to the AAST classificatino.All of the patients were treated by surgery,83.7% percent of them with debridement and suture and omentum packing for hemostasis,49 patients undergone partial hepatectomy.The postoperative complication rate was 22.2% and mortality was 8.7%.The authors consider that to perfect the emergency treatment system,enrich the knowlege and skill of the basic personnel so that the injured can be properly treated is cruical to improve the cure rate and reduce the mortality.

Contrast of Ultrasonography in Diagnosis for Hepatorrhexis with Operative Exploration (Report of 120 Cases)

Objective To discuss the diagnosis value of ultrasonography in hepatorrhexis. Methods The contrast of ultrasonography for 120 cases of hepatorrhexis with operative exploration was made. Results All of the 120 patients were examined with ultrasonography, fragmentation of liver parenchyma in 55 cases, dehiscence of liver parenchyma in 38 cases, liver subcapsular hematoma in 12 cases, and spontaneous rupture of liver cancer in 7 cases. All of the 120 patients were confirmed hepatorrhexis with laparotomy. The positive diagnostic rate of ultrasonography in the hepatorrhexis was 93.3%. Conclusion Ultrasonography is valuable for diagnosing hepatorrhexis and it is one of the important diagnostic approaches.

肝外傷手術治療54例報告

心肺復蘇并發冠狀動脈破裂及遲發性肝破裂一例并文獻復習

目的總結分析心肺復蘇（CPR）患者的近期與遠期并發癥。方法對 1 例肺癌術后 CPR 并發冠狀動脈及遲發性肝破裂患者的臨床資料，結合文獻復習進行分析。總結其臨床特點，診治方案與預后。結果患者女，66 歲，左肺腺癌（T1bN0M0，Ia 期），行左上肺肺癌根治術，術后 13 h 突發心跳驟停，給予 CPR 2 h，期間出現失血性休克，床邊開胸探查，發現冠狀動脈左前降支有一破損口；CPR 后第 12 天，再次失血性休克，腹部超聲：肝臟破裂出血，予內科保守治療后，出血吸收。術后 3 個月，神志恢復，格拉斯哥昏迷量表評分 9 分，轉下級醫院繼續康復。文獻檢索后經篩選剔除，共檢索到相關文獻 14 篇。35 例冠狀動脈破裂（尸體解剖回顧性研究）、34 例肝破裂（個案報道）。肝破裂病死率高達 70.6%。左肝比右肝破裂多，大部分通過 CT/超聲診斷。治療上包括手術、保守、肝動脈栓塞。結論CPR 合并冠狀動脈、肝破裂患者，起病急，病死率高。臨床上需警惕、避免、甄別 CPR 并發癥，做到早診斷、早治療。