腹腔镜治疗肝外伤的临床体会

Clinical experience of laparoscopic treatment for liver trauma

目的研究腹腔镜在肝外伤治疗的应用价值。方法该院于2010年01月～2010年12月应用腹腔镜治疗肝外伤11例,腹部闭合伤9例,其中交通事故5例,挤压伤3例,坠落伤1例;刀刺伤2例。合并其他脏器损伤4例,合并小肠破裂2例,脾破裂1例,横结肠挫伤1例。参照Moore分级标准:Ⅰ级2例,Ⅱ级7例,Ⅲ级1例,Ⅳ级1例。合并其他脏器损伤者,同时在腹腔镜下予以处理。结果用腹腔镜完成治疗10例(其中1例用手助器完成),1例中转开腹,所有病例均无严重并发症及死亡。手术时间为50～180 min,平均手术时间70min。1例患者出现胆漏,经治疗后痊愈出院。结论腹腔镜技术对肝脏外伤的诊治具有独到的价值,适时应用腹腔镜技术治疗肝外伤可以达到满意的效果。

[ Objective ] To evaluate the application of laparoseopy for the treatment of liver trauma. [ Methods ] From January 2010 - December 2010, 11 patients received laparoscopic treatment for liver trauma in our hospital, and they were cured successfully. Among the group of 11 patients, 9 cases were closed abdominal injury, including traffic accidents in 5 cases, 3 cases of crush injury, fall injury in 1 case, stab wound in 2 cases, combined with other organ injuries in 4 cases, 2 cases of combined rupture of small intestine, spleen rupture in 1 case, transverse colon contusion in 1 ease. According to Moore Classification standards, 2 cases were type I , 7 cases type III, 1 case type III, 1 case type IV. The patients combined other organ injury were treated using laparoscope simultaneously. [ Re- sldts] 10 patients were treated with laparoscopy completely . （including 1 case with hand-assistant device to com- plete）, 1 were converted to laparotomy, all patients had no serious complications and death. Operative time was 50 - 180min, the average operation time was 70min. 1 patient suffered from bile leakage were cured after treatment. [ Conclusions ] Laparoscopic diagnosis and treatment for liver trauma has unique value, timely application of laparo- seopie treatment for liver trauma can achieve satisfactory results.