摘要
目的分析影响肝外伤手术死亡的危险因素，探讨其临床意义。方法根据AAST和ISS标准，回顾性分析90例肝外伤手术病例．对影响手术死亡的危险因素进行单因素比较和Logistic回归分析。结果死亡15例，其中Ⅲ级2例、Ⅳ级4例、Ⅴ级9例，总体手术死亡率17％。Ⅳ～Ⅴ级肝外伤手术方式的单因素比较提示；清创性肝切除术的相对危险度是0.73；而规则性肝切除术、肝静脉或肝后下腔静脉修补术相对危险度分别是1．32、1.52。Logistic回归分析提示：ISS分会和术中失血量是影响手术死亡率的2个独立因素。结论ISS分值、术中失出血量和手术方式是影响肝外伤手术死亡的3个重要因素，娴熟的手术技能和合理的手术方式可以减少术中出血量和降低手术死亡率。
Objective To analysis the risk factors determining operative mortality in blunt hepatic injuries and evaluate their clinical significance Methods According to American Association Surgery of Trauma（AAST） and injury severity sore （ISS） ,this was a retrospective case study of 90 patients with blunt hepatic injuries managed operatively. Statistical analysis was performed suing univariate analysis and multivariate logistic regression. Results 15 patients died with 2 in grade lit ,4 in grade Ⅳ ,9 in grade Ⅴ ,and the overall operative mortality was 17%. Comparison of surgical treatment of grade Ⅳ-Ⅴ hepatic injuries indicated：relative hazard ratio（HR） of debridement hepateetomy was 0. 73;HR of anatomical hepatectomy and venorrhaphy of major hepatic vein and retrohepatie vena cava were 1.32 and 1.52 respectively. Multivariate Logistic regression indicated：ISS and total intraoperative blood loss were two independent predictors of the operative mortality. Conclusions ISS, total intraoperative blood loss and surgical management are the signicant factors that influence the operative mortality for blunt hepatic injuries. Skilled operative technical and appropriate surgical management, to control operative blood loss, are helpful to reduce opera-tive mortality in patients with blunt hepatic trauma.
出处
《肝胆外科杂志》
2006年第2期97-100,共4页
Journal of Hepatobiliary Surgery
关键词
肝外伤
手术死亡
危险因素
Blunt hepatic injuries；Operative mortality； Risk factors.
