探讨肝外伤非手术治疗的可行性和临床疗效。

回顾性分析2001年1月至2011年12月在上海大场医院普外科、复旦大学附属华山医院宝山分院普外一科和同济大学附属同济医院普外二科共收治的68例肝外伤非手术治疗患者的临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男性57例，女性11例，年龄7~65岁，中位年龄34岁。按美国外科创伤协会（ASST）制定的肝外伤分级，Ⅰ级35例（51%），Ⅱ级29例（43%），Ⅲ级4例（6%）。治疗措施包括：要求患者严格卧床休息，禁食、胃肠减压，给予输液、输血，维持水电解质平衡和血流动力学稳定，应用促凝血药及抗生素等非手术治疗；严密观察患者血压、心率、脉搏、血红蛋白、红细胞压积变化及腹部体征变化；定期或按实际情况随时进行超声或计算机断层摄影术（CT）检查；积极处理合并伤。观察非手术治疗过程中中转开腹手术、并发症及死亡发生情况；出院后随访，行超声检查肝外伤愈合情况。

68例中66例患者治愈出院（肝外伤Ⅲ级4例），成功率为97%；另外2例中转开腹手术治疗，治愈。出院后55例患者获随访，随访平均时间6个月，超声检查显示肝脏裂口愈合良好，血肿吸收完全。

对ASST Ⅲ级以下的肝外伤患者，严格掌握非手术治疗的适应证，在严密监测的前提下采取积极有效的非手术治疗措施，是安全有效的。

To investigate the feasibility and clinical effect of non-surgical treatment of patients with liver trauma.

Clinical data of 68 liver trauma patients receiving non-surgical treatment in three centers including Department of General Surgery in Dachang Hospital of Shanghai, Department Ⅱ of General Surgery in Tongji Affiliated Hospital of Tongji University and Department Ⅰ of General Surgery, in Baoshan Campus of Huashan Affiliated Hospital, Fudan University, from January 2001 to December 2011, were analyzed retrospectively. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. Fifty-seven patients were males and 11 were females. The age of patients were from 7 to 65 years old with the mean age of 34 years old. According to the liver trauma grading of American Association for Surgery of Trauma(ASST), 35 patients (51%) were grade Ⅰ, 29(43%) were grade Ⅱ and 4(6%) were grade Ⅲ. All patients were given non-surgical treatment including strict bed rest, fasting, gastrointestinal decompression, fluid infusion, blood transfusion and so on. The water electrolyte balance and hemodynamic stability were carefully monitored and maintained. Hemostatics and antibiotics were also applied. The blood pressure, pulse, heart rate, changes of hemoglobin and hematocrit and abdominal symptoms were observed. Ultrasonic examination or computed tomography (CT) as well as appropriate treatment of associated injuries were given to all patients regularly or under necessary circumstances. The related complications and mortality of those patients, who were converted to open surgery, were observed. All patients were followed up after operation. The recovering of liver trauma was monitored by ultrasonography.

Sixty-six patients including 4 cases with grade Ⅲ of liver trauma recovered successfully with 97% successful rate. The other 2 cases underwent operation and recovered well. No complications and death occurred. Fifty-five patients were followed up for an average time of 6 months. The ultrasonography showed that the wound of the injured liver recovered and the hematoma was absorbed.

The non-surgical treatment for liver trauma is feasible and effective with carefully monitoring, close observation, effective treatment as well as thorough understanding of indications for surgery.