带蒂大网膜在严重肝损伤治疗中的应用

Use of pedicle greater omentum in the treatment of severe liver injury

目的 探讨应用带蒂大网膜治疗严重肝损伤的方法及局限性。方法 回顾性总结1980年 6月至 1998年 6月收治的严重肝损伤应用带蒂大网膜治疗的病例 6 8例的临床资料进行分析。结果 直视下带蒂大网膜填塞缝合术 5 4% (37/ 6 8) ,盲目带蒂大网膜填塞压迫术 9% (6 / 6 8) ,带蒂大网膜覆盖肝断面 37% (2 5 / 6 8)。其中 98% (6 7/ 6 8)手术治愈 ,死亡率 1% (1/ 6 8)。术后胆瘘 4% (3/ 6 8) ,继发性肝出血 4% (3/ 6 8) ,膈下脓肿 2 0 % (14/ 6 8) ,胆管出血 3% (2 / 6 8)。结论 带蒂大网膜在治疗严重肝损伤中有着重要的作用。对肝创面彻底清创 ,严格止血 ,稳妥缝扎胆汁渗漏处等是应用带蒂大网膜的先决条件。大网膜的填塞和包裹应有一定的压力 ,而盲目大网膜填塞压迫应慎用。

Objective[WT5”BZ] To evaluate the use of pedicle greater omentum for the treatment of severe liver trauma.[WT5”HZ] Method[WT5”BZ] The outcome of 68 cases with severe liver damage from June 1980 to June 1998 treated by using pedicle greater omentum was retrospectively analyzed.[WT5”HZ] Results[WT5”BZ] Thirty seven cases (54%) underwent packing suture of pedicle greater omentum under direct vision,blind tamponade and compression of the pedicle greater omentum was used in 6 cases (9%),overlying of bleeding edge of the liver with pedicle greater omentum was used in 25 cases (37%).Sixty seven cases was cured (98%), the mortality rate was 1%(1/68). Biliary fistula developed in 3 cases (4%),Secondary bleeding occured in 3 (4 4%).Subphrenic abscess ensued in 14 (20%), and the biliary tract bleeding was complicated in 3%(2/68).[WT5”HZ] Conclusion[WT5”BZ] The pedicle greater omentum could be of an important role in the treatment of severe liver damage. Complete debridement of liver damage, satisfactory hemostasis and the repairing of lacerated injury of the biliary tract were mandatory before the use of pedicle greater omentum. The packing and overlaying of pedicle greater omentum in the treatment of liver injury need to be applied under certain pressure.The result of blind tamponade and compression of the omentum was less satisfactory.