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題 名 | Experiences in the Treatment of Hepatic Trauma=肝臟創傷治療之經驗 |
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作 者 | 林漢鎮; 黃宗人; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 10:2 1977.06[民66.06] |
頁 次 | 頁105-113 |
關鍵詞 | 肝臟; 創傷治療; |
語 文 | 英文(English) |
中文摘要 | 肝臟創傷是相當難以處置的疾患,因大量急速出血,常使病人死於輸送途中或持久性休克,開刀治療,是唯一的治療方法。然而,手術處理不當,往往會造成許多合併症,有時可致命,有時領施行多次開刀。故治療肝臟創傷的病人須輸送迅速,早期開刀,爭取時效,快速輸血,避免持久性休克,適當的開刀方法,以避免嚴重的合併症。 自1965年7月至1976年10月,高雄醫學院經驗了65個肝臟創傷的病例,大都是意外事件所引起,尤其是車禍為最常見的致因。其中13例死亡,死亡率為19.4%。主要症狀為腹部壓痛,尤其是右上腹部,其次為急速失血所致之休克,蒼白等等。 貫穿性創傷均立即作剖腹探查,鈍性創傷,則以腹腔穿刺證明腹內出血,便作緊急手術,以腹腔灌洗法輔助腹腔穿刺來證明腹內出血,其精確度高達94%。 手術的方法,視肝臟創傷之形狀,範圍的大小而定,有簡單的縫合術,或加上網膜,Gelfoain塞置,或肝動脈結紮,部份肝切除術以及肝葉切除術等。 肝臟創傷常合併身體其他部位之創傷;有頭部外傷,血胸,肺部創傷,骨折,消化管破裂等等,且常為致命的主因或添加因素。死亡的原因為持久性休克,不能控制的出血,呼吸失調,嚴重的併發創傷以及術後再出血。術後的合併症,有胸膜積水,肝壞死,傷口感染,術後出血,橫隔膜下膿瘍,腸阻塞,黃疸,膽血症,膽道瘻管等等。 |
英文摘要 | 1.During the period between July, 1965 and October 1976, 67 cases of hepatic injury, 51 male and 16 female, had been treated at the Koahsiung Medical Collage Hospital. 2. There were 13 cases of penetrating injury, without mortality. Among 54 cases of blunt injury, 13 cases died. The overall mortality rate is 19.4%. 3. Concerning about the cause of hepatic injury, the majority were of accident in nature, of which traffic accidents were by far the principle cause. 4. The most confirmative diagnostic method was abdominal paracentesis. If it was supplemented with peritoneal lavage, the accuracy rate reached as high as 94%. 5. Hepatic injuries were frequently associated with multiple severe injuries of other parts of the body which contributed more or less to the causes of death. 6. The liver was more often assaulted in the right lobe (42 cases) than in the left (18 cases). Bilateral injuries were observed in 5 cases. Rupture of the inferior vena cava and hepatic vein were enconntered in one each respectively. 7. The guiding principles of surgical management were complete hemostasis, thorough debridement, adequate drainage and avoiding dead space. Various kinds of surgical procedure such as suture with or without packing, partical resection, lobectomy and hepatic artery ligation, etc. were carried out according to the nature of hepatic wounds. We did not recommend biliary decompression as a mean of preventing the development of biliary fistula. 8. The postoperative complications were not uncommon. Most cases with postoperative bleeding hepatic necrosis and abscess, biliary fistula, recovered spontaneously from the benefit of external drainage. |
本系統中英文摘要資訊取自各篇刊載內容。