第二肝门肝损伤不同手术方法的疗效分析

HEPATIC INJURIES AROUND THE SECOND HIL US TREATED BY DIFFERENT OPERATIONS.

目的 对比分析在不合并肝静脉损伤的情况下采用填塞缝扎法治疗近第二肝门肝损伤的止血效果 ;以及在合并肝静脉损伤的情况下采用肝静脉缝扎法治疗近第二肝门肝损伤的止血效果。方法 依据是否合并肝静脉损伤 ,将病人分为普通第二肝门肝损伤组和肝静脉损伤组 ;分别统计分析普通组中缝合法 (17例 )、填塞加缝合法 (15例 )以及填塞法 (10例 )的术后出血量 ;然后再统计分析肝静脉损伤组中肝静脉缝扎组 (9例 )和修补组 (11例 )病人术后出血量。结果 普通组中缝合法、填塞加缝合法以及填塞法的术后 2 4 h出血量分别是 780± 35 6 m l、373± 4 1ml和 4 82± 176 ml,P<0 .0 5 ;肝静脉损伤组中肝静脉缝扎组和修补组病人术后 2 4 h出血量分别是 2 19± 15 2 m l和 2 37± 132 ml,P>0 .0 5。结论 从术后 2 4 h出血量来看 ,填塞加缝合法治疗普通近第二肝门肝损伤的疗效最好 ;当合并有肝静脉损伤时 ,肝静脉缝扎是最简单、快速、有效的止血方法 。

Objective Hemostatic efficiency of both tam ping- suture and ligation of hepatic vein for hepatic injuries around the second hilus were studied prospectively in patients without and with hepatic vein injuries.Methods According to with or without hepatic vein injuries,patients were classified into common injury group and hepatic vein injury group.The postoperative blood loss within2 4 h in comm on patient group treated by suture(17) ,tamping- suture(15 ) and tamping(10 ) were cumulated respectively m eanwhile the same one in hepatic vein injury group treated by ligation of hepatic(9) vein and neoplasty(11) were also cumulated.Results The postoperative blood loss within2 4 h in common patientgroup treated by su- ture,tam ping- suture and tamping were780± 35 6 ml.373± 14 1m l and4 82± 176 ml respectively,P<0 .0 5 ;the same one in hepatic vein injury group treated by ligation of hepatic vein and neoplasty were2 19± 15 2 m l and2 37± 132 ml,P>0 .0 5 .Con- clusions According to the postoperative blood loss within2 4 h,if there was no hepatic vein injured,the best treatm ent for hepatic injuries around the second hilus was tam ping- suture;when hepatic vein injury occurred,ligation of hepatic vein was the sim plest,the quickest and the most efficient hemostatic treatment.