Zhou Chengxiao,Qi Shiqin,Bian Jian,et al.Clinical diagnosis and treatment of closed hepatic trauma in children[J].Journal of Clinical Pediatric Surgery,,19():538-543.[doi:10.3969/j.issn.1671-6353.2020.06.015]
Clinical diagnosis and treatment of closed hepatic trauma in children
- CLC:
- R641;R604;R605
- Abstract:
- Objective To explore the clinical characteristics,diagnosis and treatment of blunt hepatic trauma in children.Methods From December 2012 to June 2018,retrospective analysis was performed for clinical data of 42 children with blunt hepatic trauma.They were divided into non-operative (n=34) and interventional therapy (n=8) groups.Both groups were analyzed with regards to patient history,clinical manifestations,combined injuries or not,changes of abdomen computed tomography (CT),systolic blood pressure (SBP),hemoglobin (HB),alanine aminotransferase (ALT),total bilirubin (TBIL),prothrombin time (PT) and American Association for the Surgery of Trauma (AAST) grading of hepatic trauma at admission.Then therapeutic options were determined.Results In non-operative group,33 cases (97.1%) were cured and 1 case died of cerebral hernia.One case of delayed subcapsular hematoma rupture underwent interventional hemostasis while another one case of active hemorrhage from right anterior lobe laceration was managed by debridement partial hepatectomy and liver repair.Biliary leakage (n=2) and perihepatic abscess (n=2) were treated by B-ultrasound guided puncture and drainage.There was one case of pulmonary infection.All survivors recovered and were discharged from hospital.In interventional therapy group,the success rate of technical operation was 100%.Two cases of biliary leakage underwent B-ultrasound guided puncture and drainage.All survivors were cured and discharged and there was no occurrence of hemorrhage or biliary stricture during follow-ups.The inter-group differences in SBP,HB and ALT were statistically significant (P<0.05) while the difference in PT was statistically insignificant (P>0.05).Conclusion Most cases of Ⅰ/Ⅱ level of liver injury hemorrhage may be cured by non-operative measures while surgery is required for a minority.Hemodynamic stability Ⅲ/Ⅳ level of liver injury hemorrhage is managed preferably with interventional angiography embolization.Making a definite diagnosis and timely treatment are possible.
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Memo
收稿日期:2019-08-19。
通讯作者:戚士芹,Email:qishiqin@163.com