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題 名 | 成人肝臟鈍傷之非手術性治療 |
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作 者 | 陳梓泓; 賴福明; 張子明; 陳之凱; 沈國樑; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 26:4 民82.07-08 |
頁 次 | 頁1872-1878 |
分類號 | 416.246 |
關鍵詞 | 肝臟鈍傷; 非手術性治療; Blunt liver trauma; Nonoperative management; |
語 文 | 中文(Chinese) |
中文摘要 | 腹部電腦斷層攝影在臨床上之廣泛使用,對於肝臟鈍挫傷嚴重程度有很精確的評估能力,使得部分病人可以接受保守性治療。自1985年7月至1991年7月,本院計有57位患者因腹部鈍挫傷合併肝臟創傷住院。其中25例患者接受了非手術性治療佔44%。患者皆由腹部電腦斷層攝影確立診斷,其中22例為第二度肝臟創傷,3例為第三度創傷。12例患者合併有腹膜腔內積血。病人之住院天數在5天至70天之間,平均住院天數為26天。無併發症或腹腔內其他創傷延誤診斷的情形發生,亦未發生延遲性肝臟出血的案例。病人中有1例因血腫持續存在及形成偽動脈瘤而接受手術。25例患者有2例非肝因性死亡,死亡率為8%。腹部鈍傷病人,如血流動力狀況穩定,而腹部電腦斷層攝影確定為肝臟被膜下血腫,或肝內血腫,或草葉之肝臟撕裂傷,且無其他腹部器官明顯的創傷時,即可考慮非手術性治療。 |
英文摘要 | Computed tomography (CT) scan after blunt abdominal trauma has allowed nonoperative management of selected patients with liver injuries. From July, 1985 through May, 1991, reports of 57 adults with blunt liver injuries were collected. Twenty-five patients (25/57, 44%) received nonoperative management. All patients were identified by abdominal CT scan. Twenty-two of these hepatic injuries were relatively minor (Moore's grade II), and three cases were considered major (Moore's grade III). Free intraperitoneal blood in a small to large amount was evident on CT in 12 patients. The hospital days ranged from 5 to 70 days, with 26 days in average. There were no complications, no known missed intra-abdominal injuries and no delayed hepatic hemorrhage. One patient received a delayed laparotomy because of intrahepatic pseudoaneurysm formation. The non-hepatic-origin mortality rate was 8% (2/25). One patient died of severe head injury, and the other died of delayed rupture of an intrathoracic major vessel with hemorrhagic shock. Patients were considered nonoperative only if they were hemodynamically stable with CT finding of subcapsular hematoma, intrahepatic hematoma, or unilobar fracture (Moore's grade I,/II/,or III), with absence of other significant intra-abdominal organ injuries. Nonoperative management of blunt liver injury based on abdominal CT findings is an useful alternative in a select group of hemodynamically stable patlents. |
本系統中英文摘要資訊取自各篇刊載內容。