肝外伤选择不同术式意义的探讨

Discussion on the significance of different surgical procedures in treatment of hepatic injuries

目的探讨不同术式综合应用对不同程度不同类型肝外伤的治疗效果。方法分析我院1998年1月至2004年11月经手术治疗肝外伤49例的手术方式:肝缝合修补术7例;肝修补加门静脉裂口修补1例;肝动脉结扎加肝缝合修补3例;肝切开缝扎术(应用手指折断技术即FFT肝造口选择性血管胆管缝扎,缝合肝裂口)17例;清创性肝切除18例,其中5例另行肝右静脉缝扎,3例另行肝右静脉缝扎加肝后下腔静脉修补;规则性肝切除3例(右半肝2例,左外叶1例),其中2例另行肝后下腔静脉修补。结果除3例术前因重度休克,术中出现不可逆DIC,术后因MODS死亡外,其他病例均抢救成功,死亡率6.12%,无严重术后并发症。结论正确的术式选择是提高严重肝外伤疗效的关键。手术过程不能局限于肝表面止血,肝内管道处理更为重要;肝切开缝扎术及清创性肝切除术适用于大宗肝外伤病例。

Objective To investigate outcome of the different surgical procedures in different types of hepatic injuries to varying degrees in order to improve treatment for severe patients. Methods Forty- nine cases of hepatic trauma undergoing surgical treatment were analyzed in our hospital from Jan. 1998 to Nov. 2004. Seven cases underwent hepatic repair,one did both hepatic and portal vein repair,and 3 cases did hepatic artery ligation and hepatic repair, 17 cases did orthoptic hepatic repair by incision, with selective angiocholangeal ligation for cleft by finger fracture technique, 18 cases did debridement,among them 5 cases were subjected to ligation of right hepatic vein and 3 to ligation of right hepatic vein with retrohepatic caval repair,3 cases did anatomic hepatectomy （2 at right and 1 at left）,in which retrohepatic caval repair was performed on 2 cases. Results Except 3 cases died because of severe shock preoperatively, irreversible DIC interoperatively, and MODS postoperatively, all the others were cured without obvious complications, with 6.12% of mortality. Conclusion Correct surgical procedure for severe liver injury is crucial for a better curative effect. Surgical procedure for liver injury is not limited to the surfactant hemostasis of liver, the disposal of intrahepatic biliary tract is more important; In addition, orthoptic hepatic repair by incision and debridement are suitable for large number of hepatic injuries.