网片包裹法手术治疗严重肝外伤23例

Surgical treatment with mesh wrapping of twenty-three patients with severe hepatic trauma

目的探讨严重肝外伤采用网片包裹法的手术方法和治疗效果。方法回顾性分析1998年1月至2010年1月我院采用网片包裹法手术治疗的严重肝外伤23例,AASTⅢ级10例,Ⅳ级7例,Ⅴ级6例。结果全部患者采用网片包裹法手术治疗,治愈21例,治愈率91.30%,死亡2例,死亡率8.70%,其中死于多器官功能衰竭综合征(MODS)1例,失血性休克1例。术后出现并发症3例(13.04%),其中肺部感染1例,保守治疗治愈,胆瘘1例,B超引导下穿刺置管引流治愈,MODS1例,死亡。结论网片包裹法手术治疗严重肝外伤效果确切,可明显提高救治成功率。

Objective To explore the management strategy and effect of mesh wrapping for hepatic trauma. Methods The clinical data of 23 patients with severe hepatic trauma were selected in the period from January 1998 to January 2010. Preference of and perioperative therapies were analyzed retrospectively. Among them, there were 10 cases of grade m , 7 cases of grade IV, 6 cases of grade V. Results Mesh wrapping was performed in all of the patients. The cure rate was 91.30% with 21 cases, and the mortality rate was 8.70% with 2 cases. One died of MODS, while the other died of hemorrhagic shock. The postoperative complications incidence was as low as 13.04% （pulmonary infection occurred in 1 case, who was cured through conservative treatment; biliary fistula occurred in 1 case, who was cured through sufficient drainage and MODS occurred in 1 case who died at last）. Conclusion It is effective of mesh wrapping for treatment of severe hepatic trauma, and the therapetuic achievement ratio could be obviously elevated.