窥镜辅助下刺绣式大跨度贯穿缝合在严重肝损伤治疗中的作用

Application of wide range transfixion suture hepatic tissue with severe injury via endoscopic assistance by embroidery pattern

目的探讨窥镜辅助下用硬膜外穿刺针大跨度贯穿缝合治疗的效果。方法37例Ⅲ、Ⅳ级肝损伤用16F硬膜外穿刺针“刺绣”式送线,窥镜辅助下出线大跨度贯穿对拢缝合修补。其中1例附加肝固有动脉结扎,2例右肝动脉结扎,5例加用网膜填塞。结果该组均治愈,3例术后黄疸,4例胆漏,合并右胸少至中量积液16例。结论窥镜辅助下大跨度贯穿缝合治疗严重肝损伤适用于Ⅲ、Ⅳ级肝损伤(Moore分型),疗效好,并发症少,优于传统缝合法。

[Objective] To investigate the efficacy of the treatment of wide range transfixion suture the hepatic tissue with severe injury via endoscopic assistance through epidural puncture needle. [Methods] 37 patients with liver injury of class m, IV were applied epidural puncture needle （type 16th） to wide range transfixion suture the hepatic tissue via endoscopic assistance by embroidery pattem. Among them, one patient＇s proper hepatic artery was liggated, two patients＇ fight hepatic artery were ligated and five patients were pecked with omentum additionally.[Results] Postoperative complications occurred in 24 cases including three cases of jaundice, 4 cases of leakage of biliary tract, 16 case of slight or medium hydrothorax. [Conclusions] The treatment of wide range transfixion suture the hepatic tissue with severe injury can be applied to liver injury of class m, IV（more type）. It is efficient with low complications and superior to the traditional suture treatment.