Zhou Chengxiao,Qi Shiqin,Bian Jian,et al.Clinical diagnosis and treatment of closed hepatic trauma in children[J].Journal of Clinical Pediatric Surgery,2020,19(06):538-543.[doi:10.3969/j.issn.1671-6353.2020.06.015]
儿童闭合性肝外伤临床诊治分析
- Title:
- Clinical diagnosis and treatment of closed hepatic trauma in children
- 分类号:
- R641;R604;R605
- 摘要:
- 目的 探讨儿童闭合性肝外伤的临床特点和诊治方法。方法 回顾性分析安徽省儿童医院2012年12月至2018年6月收治的42例肝外伤患儿临床资料，依据治疗方法的不同分为保守治疗组（n=34）和介入治疗组（n=8），依据病史、腹部体征、有无合并伤、收缩压、血红蛋白、谷丙转氨酶、血胆红素、凝血酶原时间、美国创伤外科协会（American Association for the Surgery of Trauma，AAST）肝脏损伤分级等指标进行综合分析，选择恰当治疗方式。结果 本组42例闭合性肝外伤患儿中，保守治疗34例，治愈33例，治愈率为97.1％，1例因脑疝死亡。1例包膜下延迟性血肿破裂予介入止血，1例肝右前叶裂伤活动性出血行清创性肝部分切除加肝修补术，2例胆漏和2例肝周脓肿患儿予B超引导下定位穿刺引流，1例肺部感染；除1例死亡外，其余患儿痊愈出院。介入治疗组共8例患儿，治疗成功率100％，其中2例发生胆漏的患儿经B超引导定位穿刺引流，痊愈出院。所有患儿随访未见出血、胆道狭窄的发生。两组患儿治疗前后收缩压、血红蛋白、谷丙转氨酶及血胆红素比较差异有统计学意义（P<0.05），而凝血酶原时间比较差异无统计学意义（P>0.05）。结论 大部分Ⅰ、Ⅱ级闭合性肝外伤患儿通过保守治疗可治愈，小部分患儿需要手术治疗；血流动力学稳定的Ⅲ、Ⅳ级肝外伤可首选介入治疗，既能明确诊断，又能及时治疗。
- 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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备注/Memo
收稿日期:2019-08-19。
通讯作者:戚士芹,Email:qishiqin@163.com