可吸收网套在严重肝外伤的应用

The Application of Absorbable Mesh Wrap on Hepatic Trauma

目的总结可吸收网套治疗肝破裂的应用经验以及评价可吸收网套在治疗肝外伤的临床价值。方法回顾性分析13例肝外伤病人的诊断和采用可吸收网套包裹固定肝破裂的手术方法,其中按照AAST分级,III级7例,IV级6例。修补方法为取两张大小26.5cm×21.5cm Vicrylmesh补片,缝合形成一个网套。将其套入破裂肝脏包裹后缝合,并维持一定张力以达到止血目的。结果除1例术中死于大出血休克外,12例肝破裂病人接受了可吸收网套止血修补法。12例病人中有术后发热7例、肝内血肿3例、膈下感染积液1例,但未见有术后再次出血、术后感染等严重并发症,手术效果良好。结论可吸收网套对于治疗肝外伤具有独特优越性,具有临床实用价值。

Objective To sum up our experience in management of hepatic trauma with an absorbable mesh and assess of this conservative hepatieorraphy. Methods 13 eases with hepatic trauma, according to AAST categorized as Ⅲ （7 eases）and Ⅳ （6 eases） were studied retrospectively. 13 patients had an absorbable mesh wrapping in injured liver during a primary operative procedure, with two layer of polyglaetin 901 measured 26.5cm × 21.5cm. Results One patient died of corpus bleeding and severe shock during operation. In 12 patients, postoperative fever 7 cases, introhepatic hematoma 3 cases and subdiaphramtic infection 1 case, they, however, had satisfactory outcomes without a reexploration for secondary hemorrhagic or ischemie liver. Conclusion Absorbable mesh wrapping is a valuable alternative that may promote the repair of more severe grades of hepatic trauma.