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成人肝创伤的处理

Authors
Ashley Britton Christmas, MD, FACS
David G Jacobs, MD
Section Editor
Heidi L Frankel, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
鲁建国, 主任医师，教授

引言

肝脏是最常受伤的腹部器官。大多数肝脏损伤相对较轻，通过观察及必要时行肝动脉造影及栓塞术等非手术治疗可自行愈合[1,2]。约有14%的患者需要手术干预处理肝损伤，包括最初表现为血流动力学不稳定或非手术治疗失败的患者[2,3]。

成人肝损伤的诊断和治疗总结在此。肝损伤的手术技术将在别处详细讨论。 (参见“处理肝脏损伤的外科技术”)

损伤机制

肝脏是腹部钝挫伤中最常受伤的器官，在腹部穿通伤最常受累器官中排在第2位[3-6]。肝脏是位于右上腹富含血管的器官(图 1)，容易受到因创伤机制受到损伤。在钝挫伤患者中，机动车辆碰撞是最常见的损伤机制[3]。在肝穿通伤患者中，损伤的严重程度取决于伤道或穿入物，损伤的范围可以从单纯的肝脏实质损伤到大血管撕裂。

通常在右侧肋缘下2-3cm处可以触诊到肝脏边缘，其在呼吸过程中会随膈肌而升降。呼气时，肝脏的顶部上升至高达T4(乳头)平面。因此，胸壁损伤常伴随显著的肝损伤。同样，深吸气时，肝脏下缘可下降至T12平面，腹部损伤，尤其是穿通伤，可能伤及比预期腹部位置更低的肝脏。 在钝挫伤中，肝右叶后部分(图 2)是肝损伤最常见部位[7]。

创伤评估

我们根据美国外科医师协会创伤委员会建立的高级创伤生命支持(Advanced Trauma Life Support,ATLS)项目的方案，对钝挫伤或穿通伤患者实施初始复苏、诊断性评估和处理创伤。腹部或胸部钝挫伤或穿通伤患者的初始复苏和评估将在别处详细讨论。

                

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Literature review current through: 2017-06 . | This topic last updated: 2016-08-25.
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