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儿童腹部钝挫伤中的肝、脾及胰腺损伤

Author
David E Wesson, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
洪玉才, 副主任医师

引言

肝脾损伤是儿童钝挫伤中最常见且可能危及生命的腹腔内损伤(intraabdominal injury, IAI)。胰腺损伤并不常见，但如果有大的胰管断裂，则可能导致腹膜炎或假性囊肿。这3种损伤类型的预后都主要取决于是否存在合并伤，尤其是脑和胸部损伤。

本专题将总结儿童腹部钝挫伤中肝、脾及胰腺损伤的诊断和治疗。儿童腹部钝挫伤的一般处理方法，儿童腹部钝挫伤后空腔脏器损伤的诊断和治疗将单独讨论。 (参见“Overview of blunt abdominal trauma in children”和“Hollow viscus blunt abdominal trauma in children”)

流行病学

腹部钝挫伤占儿童损伤的10%-15%[1]。实体器官损伤在严重创伤儿童中很常见，其中单纯脾损伤最多见[2]。肝、脾和胰腺损伤有两种典型的形式：直接打击上腹部所致的单纯性损伤，或者由高能机制(如，机动车辆或全地形车碰撞事故、从高处坠落)导致的多系统损伤[1]。这些器官的单纯性损伤更常见，但合并多系统损伤者更可能危及生命，有报道称其死亡率高达12%[3]。

相关解剖

肝、脾及胰腺位于上腹部，部分受肋骨保护。儿童的这种保护作用不如成人，因为他们的肋骨很软，而且肝脾可向下延伸至肋缘下，在婴幼儿中尤其如此。此外，儿童的内脏相对较大、脂肪覆盖较少、且腹部肌肉组织较薄弱。儿童中几乎所有肝、脾及胰腺损伤都由钝性暴力造成。损伤机制可能是直接打击上腹部使腹壁变形、急骤减速所致的供血血管撕裂、肋骨骨折端刺伤或这些脏器被挤压在脊柱上。

由于肝脾血供丰富，这些脏器损伤可导致致命性失血，这些失血要么来自脏器实质，要么来自为其提供血供的动静脉。肝脾都具有重要的生理功能，但如果其他所有方法都无法止血，则可完全切除脾脏。

                     

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-25.
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