微波消融辅助治疗严重外伤性肝破裂的临床应用

Clinical application of microwave ablation in treatment of severe traumatic liver rupture

目的探讨微波消融辅助治疗在严重外伤性肝破裂患者中的临床应用价值。方法回顾性分析2012年10月至2016年6月涪陵中心医院微波消融辅助治疗42例严重外伤性肝破裂患者临床资料,观察患者治疗效果、手术时间、术中出血量及术后并发症等情况。结果 42例患者中采取单纯微波消融止血术11例,微波消融止血术加深部褥式缝合术13例,微波消融止血加部分清创肝切除术18例。治愈40例;围手术期出现3例胆瘘,2例大量腹水,4例大量胸水,2例切口感染,3例出现一过性轻度血红蛋白尿,经治疗后均恢复正常,无术后再出血、胃肠漏、肝功能衰竭并发症。出院后随访至少2个月,复查发现大量胸腔积液3例、肝脓肿2例,无死亡病例。结论微波消融辅助治疗严重外伤性肝破裂是一种相对安全、有效的方法,减少手术时间及术中出血,值得临床推广。

Objective To evaluate the clinical application value of microwave ablation assistant therapy in severe traumatic liver rupture. Methods The clinical data of 42 patients with severe traumatic liver rupture treated by microwave ablation in Fuling central hospital from October 2012 to June 2016 were retrospectively analyzed. The treatment effect, operation time, intraoperative blood loss and postoperative complications were observed. Results Among the 42 patients, simple microwave ablation bemostasis was perfm^ned in 11 cases, microwave ablation hemostasis and deep mattress suture in 13 eases and microwave ablation hemostasis debridement plus partial hepatectomy in 18 cases. Forty cases were cured. During perioperative period,3 cases of bile leakage occurred, massive ascites was found in 2 cases, massive pleural effusion was found in 4 cases ,incision infection was found in 2 cases, transient mild hemoglobinuria occurred in 3 cases. After treatment, the patients recovered to normal without postoperative bleeding, gastrointestinal leakage, liver failure or other complications. During the follow- up of at least 2 months, massive pleural effusion occurred in 3 cases,liver abscess in 2 cases, no deaths more. Conclusion Microwave abla- tion assisted treatment of severe traumatic liver rupture is a relatively safe and effective method,it can reduce operation time and intraoperative bleeding and be used in clinical practice.