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目的：总结小儿肝外伤的诊断及治疗方法．方法： １９９０年１月至１９９８年１２月，收治２２例小儿肝外伤，年龄 １岁～１４岁，平均 ６．５岁，男 １４例，女８例，按美国创伤协会（１９８９年）肝外伤 ６级分类法，本组Ⅰ～Ⅱ级８例，未合并其它脏器损伤者６例，保守治愈，余２例行清创缝合；Ⅲ－Ⅳ级肝外伤１２例，其中清创缝合５例，清创缝合加带蒂大网膜填塞４例，清创切肝２例，清创缝合＋明胶海棉肝周填塞１例；Ｖ级肝外伤１例行纱布肝周填塞２４小时后再行清创性切肝； Ⅵ级肝外伤Ⅰ创未行手术已死亡．结果：６例保守治疗者有１例发生肝创面感染，经 Ｂ超引导抽吸、中西结合抗炎治愈；手术 １５例全部成活，并创腔液化坏死 ３例，合并胸腔积液４例经Ｂ超引导抽吸、抗炎、补充白蛋白治愈，胆漏２例，引流治愈，１例Ⅳ级肝外伤合并肝管断裂经吻胆管支撑２月拨管无吻合口狭窄．结论：小儿肝外伤属紧急病例，接诊后应积极保暖，上肢双通道温林格氏液补液、抗炎。ＣＴ检查有助于分级诊断；对Ⅰ～Ⅱ级肝外伤可试行保守治疗，Ⅲ级以上者行大剖腹切口进行探查．手术原则为控制损伤，止血、止胆、引流．术中可在手箍及纱布控制出血后，用水流冲洗出积血及损伤的肝组织，手指、钳夹进行清创，对创腔浅者
Objective: To summarize the diagnosis and treatment of pediatric liver injury. METHODS: From January 1990 to December 1998, 22 cases of pediatric liver injury were treated, ranging in age from 1 year to 14 years (mean 6.5 years). There were 14 males and 8 females. According to the American Wound Association (1989) There were 6 cases classified as Ⅰ-Ⅱ in this group, 6 cases were not combined with other organ injuries, and were cured conservatively, while the remaining 2 cases were debridement and sutured. Among them, 12 cases of grade Ⅲ-Ⅳ liver trauma were treated with debridement and suture in 5 cases , Debridement suture plus pedicled omentum in 4 cases, 2 cases of debridement and hepatectomy, debridement and gelatin sponge in 1 case of hepatic filling; V grade liver trauma in 1 case of gauze liver packing 24 hours later Vocal debridement; grade Ⅵ liver injury I did not operate the surgery has died. Results: Six cases of conservative treatment of liver wound infection in 1 case, the B-guided suction, anti-inflammatory combined Chinese and Western healing; 15 cases were alive and wound cavalcy necrosis in 3 cases, 4 cases of pleural effusion by B Ultra-guided suction, anti-inflammatory, albumin albumin cure, bile leakage in 2 cases, drainage cure, 1 case of grade IV liver injury with hepatic duct rupture by kiss bile duct support February dialysis without anastomotic stenosis. Conclusion: The pediatric liver injury is an emergency case. After the admissions, the patients should be actively warm, and the upper limb dual-channel Winkinger’s fluid rehydration, anti-inflammatory. CT examination can help to grade the diagnosis; Ⅰ ~ Ⅱ grade liver injury can be conservative treatment trial, Ⅲ grade above a large laparotomy for probing. The principle of surgery for the control of injury, bleeding, gallbladder, drainage. Surgery in the hand hoop and gauze control of bleeding, the water flow rinse blood and injury of liver tissue, fingers, jaws for debridement, shallow wound cavity