目的探讨儿童重度外伤性肝破裂的治疗体会和经验。方法回顾了99年5月~2005年3月间重度肝外伤的患者有15例,患者均有明确的外伤史,外伤原因以车祸伤居首位(60%),其次为撞伤(26.7%)和坠落伤(13.3%)。根据AAST分级,其中Ⅲ级外伤10例,Ⅳ级3例,Ⅴ级2例。男性9例,女性6例,最小年龄3岁,最大年龄12岁,平均年龄6.8岁。结果大部分患者采用保守治疗,其中手术4例,1例死亡,手术比例占26.7%。1例死亡病例合并严重的颅脑外伤。在4例手术患者中,均作肝修补术和外引流术,1例同时作下腔静脉修补术。术后合并肝脓肿1例,腹腔包裹性积液3例,胸水4例。其中肝脓肿及2例腹腔积液行外引流术。术后1例死亡,14例恢复良好。结论儿童重度闭合性肝外伤的治疗以保守治疗为主,外伤状况的动态评估并结合密切的监护,一旦有变化要及时手术。 Objective To explore the experience and experience of treatment of severe traumatic liver rupture in children. Methods Fifteen patients with severe hepatic trauma from May 1999 to March 2005 were retrospectively reviewed. All patients had a clear history of trauma. The cause of trauma was the first (60%) with car accident and the second was bruising (26.7% ) And fall injuries (13.3%). According to the classification of AAST, grade Ⅲ trauma in 10 cases, grade Ⅳ in 3 cases, grade Ⅴ in 2 cases. 9 males and 6 females, the youngest was 3 years old, the oldest was 12 years old and the average age was 6.8 years old. Results Most of the patients were treated conservatively, including 4 cases of surgery and 1 case of death, accounting for 26.7% of the total cases. One case of death combined with severe traumatic brain injury. In 4 cases of surgical patients, both for liver repair and drainage, 1 case of inferior vena cava repair at the same time. Postoperative liver abscess in 1 case, abdominal cystic fluid in 3 cases, 4 cases of pleural effusion. Among them, liver abscess and 2 cases of extraperitoneal drainage were performed drainage. One patient died after operation and 14 patients recovered well. Conclusion The treatment of severe closed hepatic trauma in children is mainly conservative treatment. The dynamic assessment of traumatic conditions combined with close monitoring, once the change to timely surgery.