肝破裂腹腔镜手术62例报告

Laparoscopic Surgery for Liver Rupture:a Report of 62 Cases

目的探讨腹腔镜下肝破裂手术的可行性及临床疗效。方法我院2012年6月~2014年4月对62例外伤性肝破裂腹腔镜下采用电凝止血,止血纱布填塞,破裂口缝合止血,结扎肝动脉,清创性肝切除。结果 56例顺利完成腹腔镜下手术,手术成功率90.3%（56/62）。6例因出血过多,且难以在短时间内寻找到出血点而中转开腹,其中肝损伤Ⅲ级2例、Ⅳ级3例、Ⅴ级1例。Ⅰ、Ⅱ级患者均腹腔镜下完成手术,无中转开腹。Ⅲ级患者1例发生胆漏;Ⅳ级患者1例发生胆漏,1例发生梗阻性黄疸;Ⅴ级患者1例发生全身多器官功能障碍致死亡,1例发生胆道出血,并发症患者经积极对症治疗后顺利出院,并发症发生率8.1%（5/62）,病死率1.6%（1/62）。所有患者术后随访3个月,恢复良好。结论对于Ⅰ~Ⅲ级肝破裂腹腔镜下手术是安全可行的,对于Ⅳ、Ⅴ级肝损伤,由于患者损伤较重,中转开腹和术后发生并发症的几率增大,建议首选开腹手术。

Objective To investigate the feasibility and clinical effects of laparoscopic operation for liver rupture.Methods A retrospective analysis was made on 62 cases of traumatic rupture of liver in this hospital from June 2012 to April 2014.The techniques of hemostasis included coagulation,hemostasis gauze packing,rupture suture,hepatic artery ligation,and debridement hepatectomy.Results The laparoscopic operation was successfully completed in 56 cases,with a success rate of 90.3%（56 /62）.Conversion to open surgery was required in 6 cases due to massive hemorrhage and difficult location of lesions,including 2 cases of grade Ⅲ liver rupture,3 cases of grade Ⅳ,and 1 case of grade Ⅴ.Patients with liver rupture of grade Ⅰ and Ⅱ were all operated without conversions to laparotomy.One patient with grade Ⅲ was complicated with biliary leakage.In patients with grade Ⅳ,one was complicated by biliary leakage and another by obstructive jaundice.In patients with grade Ⅴ,one was complicated by systemic multiple organ dysfunction leading to death and another by biliary tract bleeding who was cured by active symptomatic treatment.The complication rate was 8.1%（5 /62）.The mortality rate was 1.6%（1 /62）.All the patients were followed up for three months.All the patients recovered well.Conclusion For grade Ⅰ,Ⅱ,and Ⅲ liver rupture,laparoscopic surgery is safe and feasible.But for grade Ⅳ and Ⅴ patients,laparoscopic surgery bears high rates of converting to open operation and postoperative complications,so we suggest open surgery as the first choice.