创伤性肝破裂患者损伤控制性手术后并发症发生的影响因素

摘要/Abstract

摘要： 目的探讨创伤肝破裂患者损伤控制性手术后并发症发生的影响因素。方法回顾性分析2019年1月至2023年12月厦门大学附属东南医院收治的92例接受损伤控制性手术的创伤性肝破裂患者临床资料,根据术后是否发生并发症分为并发症组(n=22)和无并发症组(n=70),采用单因素和多因素logistic回归分析评估损伤控制性手术后并发症发生影响因素;绘制受试者工作特征(ROC)曲线分析相关因素对术后并发症的评估价值。结果 92例创伤肝破裂患者均接受损伤控制性手术,术后22例发生并发症,发生率为23.91%,其中12例胆漏,5例感染,3例出血,2例多器官功能衰竭。92例患者中,美国外科创伤协会(AAST)肝损伤分级:Ⅰ级17例、Ⅱ级10例、Ⅲ级34例、Ⅳ级25例、Ⅴ级6例、Ⅵ级0例。并发症组受伤至控制性手术时间≥4 h、休克、AAST分级Ⅲ级以上、控制术后胆漏、控制术后感染、合并胆管损伤、合并其他器官损伤的发生率高于无并发症组(P<0.05)。多因素分析结果发现,受伤至控制性手术时间≥4 h(OR:7.851、95%CI:1.360～45.337)、控制术后胆漏(OR:13.780、95%CI:2.322～81.781)、控制术后感染(OR:5.634、95%CI:1.013～31.341)、合并胆管损伤(OR:6.277、95%CI:1.349～29.195)是创伤性肝破裂损伤控制性手术后并发症的危险因素。根据多因素分析模型绘制ROC曲线,曲线下面积(AUC)为0.924,灵敏度为0.914,特异度为0.727,95%CI:0.871～0.978,P<0.001。结论创伤性肝破裂患者接受损伤控制性手术后仍有较高的并发症发生率,受伤至控制性手术时间≥4 h、控制术后胆漏、控制术后感染、合并胆管损伤是并发症发生的危险因素。

关键词: 创伤性肝破裂, 胆漏, 出血, 感染, 并发症, 损伤控制性手术

Abstract: Objective To analyze the factors influencing complications after damage control surgery in patients with traumatic hepatic rupture. Methods The clinical data of 92 patients with traumatic hepatic rupture who underwent damage control surgery in Dongnan Hospital Affiliated to Xiamen University from January 2019 to December 2023 were retrospectively analyzed.They were divided into complication group (n=22) and non-complication group (n=70) according to whether postoperative complications occurred.Univariate and multivariate logistic regression analyses were performed to identify factors associated with complications after damage control surgery. According to the results of multifactor analysis, a receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of the multivariate logistic regression model for postoperative complications. Results All 92 patients with traumatic liver rupture underwent damage control surgery. Postoperative complications occurred in 22 cases (23.91%), including bile leakage in 12 cases, infection in 5 cases, hemorrhage in 3 cases and multiple organ failure in 2 cases. According to the AAST liver injury grading system, 17 patients had grade Ⅰ injuries, 10 had grade Ⅱ injuries, 34 had grade Ⅲ injuries, 25 had grade Ⅳ injuries, 6 had grade Ⅴ injuries, and none had grade Ⅵ injuries.The proportion of patients with an interval from injury to damage control surgery of ≥4 h, shock, an AAST liver injury grade of Ⅲ or higher, bile leakage after damage control surgery, postoperative infection control, bile duct injury and other organ injury in complication group was higher than that in non-complication group (P<0.05). Multivariate analysis showed that an interval from injury to damage control surgery of ≥4 h (OR:7.851, 95%CI:1.360～45.337), bile leakage after damage control surgery (OR:13.780, 95%CI: 2.322～81.781), control of postoperative infection (OR:5.634, 95%CI:1.013～31.341), combined with bile duct injury (OR: 6.277, 95%CI: 1.349～29.195) were risk factors for complications after damage control surgery for traumatic hepatic rupture.The ROC curve was drawn according to the multivariate logistic regression model. Area under the curve (AUC) was 0.924, sensitivity was 0.914, specificity was 0.727, 95%CI was 0.871～0.978, P<0.001. Conclusion Patients with traumatic liver rupture still have a high incidence of complications after receiving damage control surgery. A time from injury to damage control surgery of ≥4 h, bile leakage after damage control surgery, infection after damage control surgery, and concomitant bile duct injury are risk factors for complications.

Key words: Traumatic hepatic rupture, Bile leakage, Bleeding, Infection, Complications, Damage control surgery

陈宝坤, 周松, 陈宇凡. 创伤性肝破裂患者损伤控制性手术后并发症发生的影响因素[J]. 肝脏, 2026, 31(8): 1164-1168.

Chen Baokun, Zhou Song, Chen Yufan. Analysis of influencing factors of complications of damage control surgery in patients with traumatic hepatic rupture[J]. Chinese Hepatolgy, 2026, 31(8): 1164-1168.

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