Liver trauma: What current management?

Background: The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five years.Methods: The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were analyzed.Results: The study involved 83 patients, with a mean age of 33 years and a marked male predominance(85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries(81.9%) were of low severity(grades Ⅰ,Ⅱ,Ⅲ), while 15(18.1%) were of high severity(grade Ⅳ or greater). Fifty-six patients(67.5%) had multiple injuries. Surgical treatment was performed in 26(31.3%) patients. Non-operative management was undertaken in 57 cases(68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated group.Conclusions: Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.

Non-operative management of isolated liver trauma

Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver.METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver.RESULTS: Seven(30.4%) patients in group 1 and 10(28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8%(48/58) of the patients and penetrative trauma in 17.2%(10/58). A higher injury severity score(ISS) was observed in group 2(median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable(65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival(91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality(P = 0.004, hazard ratio = 1.035, 95%CI:CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

Right Post-Traumatic Diaphragmatic Hernia with Liver Dislocation

Diaphragmatic hernia is a rare consequence of thoraco-abdominal trauma. It may be associated with high morbidity and mortality, particularly if surgical intervention is delayed. We report a case of a right diaphragmatic hernia in a 75-year-old woman. The patient was referred to our hospital with mild dyspnea. Chest radiograph showed an overtly elevated right hemi-diaphragm. Thoracic and abdominal computed tomographic scan was requested and showed a defect of the right diaphragmatic muscle wall with intrathoracic ascension of the liver. During the postoperative course, the patient was still on mechanical ventilation, hemodynamically unstable. She developped urinary peritonitis and an extensive bowel ischemia worsening. We report this case to show that the prognosis is related to associated injuries and possible complications. The possibility of a diaphragmatic rupture should be kept in mind and surgery is mandatory in order to avoid complications.

Emergency strategies and trends in the management of liver trauma

The liver is the most frequently injured organ during abdominal trauma.The management of hepatic trauma has undergone a paradigm shift over the past several decades,with mandatory operation giving way to nonoperative treatment.Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy.Hemodynamically unstable patients should undergo focused abdominal sonography for trauma,whereas stable patients may undergo computed tomography,the standard examination protocol.The grade of liver injury alone does not accurately predict the need for operation,and nonoperative management is rapidly becoming popular for high-grade injuries.Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention.The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques.Although surgical intervention for hepatic trauma is not as common now as it was in the past,current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries,such as packing,Pringle maneuver,selective vessel ligation,resectional debridement,and parenchymal sutures.The present review presents emergency strategies and trends in the management of liver trauma.

Liver transplantation for severe hepatic trauma:Experience from a single center

Liver transplantation has been reported in the literature as an extreme intervention in cases of severe and complicated hepatic trauma.The main indications for liver transplant in such cases were uncontrollable bleeding and postoperative hepatic insufficiency.We here describe four cases of orthotopic liver transplantation after penetrating or blunt liver trauma.The indications were liver failure,extended liver necrosis,liver gangrene and multiple episodes of gastrointestinal bleeding related to portal hypertension,respectively.One patient died due to postoperative cerebral edema.The other three patients recovered well and remain on immunosuppression.Liver transplantation should be considered as a saving procedure in severe hepatic trauma,when all other treatment modalities fail.

Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

有 traumatic 以后的一个 23 岁的人肝的动脉伪动脉瘤和潜水艇膈的肝脓肿被承认。他经历了肝的动脉伪动脉瘤的卷 embolization。伪动脉瘤成功地被妨碍并且代替膈的肝脓肿被控制。超级选择的 trans 导管卷 embolization 可以表示为肝的动脉伪动脉瘤的有效治疗当另外的治疗学的选择不在时把膈的肝脓肿与潜水艇相结合。

基于损伤控制理论的救治管理对肝脏与胆管外伤患者救治效果的影响

目的 探究基于损伤控制理论的救治管理在肝脏与胆管外伤患者救治中的应用效果。方法 回顾性分析2022年8月—2023年3月收治的肝脏与胆管外伤102例的临床资料,根据临床处理方案分为观察组52例和对照组50例,对照组实施常规急诊救治,观察组实施基于损伤控制理论的救治管理。观察2组救治相关指标、并发症及干预前后损伤严重程度、氧化应激指标[髓过氧化物酶(MPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]变化情况。结果 观察组手术时间、术后肛门首次排气时间及住院时间均短于对照组,术中出血量少于对照组(P<0.01);干预后,观察组损伤严重程度轻于对照组(P<0.05);干预后,观察组血清MPO、MDA水平低于对照组,血清SOD水平高于对照组(P<0.05);观察组多器官功能障碍综合征、失血性休克发生率分别为3.85%(3/52)、1.92%(1/52),低于对照组的18.00%(9/50)、16.00%(8/50),差异有统计学意义(P<0.05)。结论 基于损伤控制理论的救治管理可降低肝脏与胆管外伤患者应激及损伤程度,加速康复进程,改善临床结局。

Effects of primary suture and fibrin sealant on hemostasis and liver regeneration in an experimental liver injury

AIM: To investigate the effects of fibrin sealant on hemostasis and liver regeneration and intra-abdominal adhesions in an experimental liver injury. METHODS: Thirty-six Wistar rats were randomly divided into primary suture group (n = 15), fibrin sealant group (n = 15) and control group (n = 6). A wedge resection was performed on the left lobe of the liver. In primary suture group, liver was sutured using polypropylene material, while fibrin glue was administrated on the liver surface in fibrin sealant group. RESULTS: More intra-abdominal adhesions were observed in the primary suture group compared to the fibrin sealant group on 3rd (2.50 ± 0.5 vs 0.25 ± 0.5, P = 0.015), 10th (2.75 ± 0.5 vs 0.50 ± 0.6, P = 0.06) and 20th (1.75 ± 0.5 vs 0.70 ± 0.5, P = 0.015) postoperative days. Histopathological scores were better in the fibrin sealant group in comparison with the primary suture group on 3rd (8.75 ± 0.5 vs 6.75 ± 0.5, P = 0.006), 10th (7.50 ± 1.0 vs 5.5 ± 0.6, P = 0.021) and 20th (6.40 ± 1.7 vs 3.20 ± 1.6, P = 0.025) postoperative days. CONCLUSION: Out data suggest that fibrin sealant is preferred over primary suture in appropriate cases including liver trauma since it causes less intra-abdominal adhesions while allowing shorter hemostasis time as assessed in experimental liver trauma.

膨胀止血材料在战创伤急救中的应用探索

目的探讨膨胀止血材料在战创伤急救中的应用价值。方法体外物理性能评价中,将聚乙烯醇(PVA)和聚醚酯-氨基甲酸乙酯(PEEC)分别置于生理盐水、抗凝兔血及生理盐水与抗凝兔血1∶1混合液中,记录2种膨胀止血材料的体积、重量变化及体积压缩一半时所需压强。体内止血性能评价中,构建大鼠股动静脉损伤出血模型和兔肝损伤出血模型,观察无菌纱布、PVA和PEEC 3种止血材料对股动静脉损伤出血和肝损伤出血的止血效果;观察记录术后1 h和术后24 h总出血量、取出止血材料后1 min出血量、取出止血材料时粘连程度和难易程度。结果在3种模拟体液中PVA的体积变化系数、体积变化速率均大于PEEC,重量变化系数小于PEEC(P均<0.01),在生理盐水和抗凝兔血中PVA体积压缩一半所需的压强小于PEEC体积压缩一半所需的压强(P均<0.05)。术后1 h,2个动物模型实验中取出PVA时的粘连程度和取出难易程度均优于无菌纱布和PEEC;取出止血材料后1 min内仅无菌纱布组动物见少量出血,PVA组、PEEC组动物均未见活动性出血。在股动静脉损伤出血模型中PVA组的术后1 h总出血量低于PEEC组(P<0.01),在肝损伤出血模型中术后1 h总出血量PVA组高于PEEC组(P<0.01)。术后24 h,2个动物模型实验中取出PVA时的粘连程度和取出难易程度均优于无菌纱布,PEEC大部分被降解,无法取出;取出止血材料后1 min内,无菌纱布、PVA、PEEC组动物均未见活动性出血。在股动静脉损伤出血模型中无菌纱布组与PVA组的24 h总出血量差异无统计学意义(P>0.05),在肝损伤出血模型中PVA组的24 h总出血量高于无菌组纱布组(P<0.01),在2个动物模型中PEEC组术后24 h总出血量均见少量出血,无法计算出血量。在股动静脉损伤出血模型中,PVA组止血材料附近肌肉组织周边浸润的炎症细胞少于无菌纱布组和PEEC组。结论PVA和PEEC均可通过吸收包括血液在内的体液使自身体积膨大控制股动静脉损伤出血和肝损伤出血,为战创伤救治新装备的研发提供了新的选择。

EVALUATION ON FACTORS INFLUENCING LIVER CANCER METASTASIS AFTER LIVER SURGERY BY A MOUSE MODEL

Objective: To evaluate the influence of surgical trauma on liver cancer metastasis. Methods: A mouse model of experimental liver cancer metastasis was established by subcapsule injecting hepatoma ascites tumor cells (H22) into spleen of NIH mice. Simple intrasplenic inoculation, with sham operation, partial hepatectomy, total occlusion of hepatic blood inflow and blood loss and re-perfusion were performed and metastatic effects were observed. Results: There were significant higher metastasis-augmenting effects in sham operation and partial hepatectomy groups. Compared with no-blood transfusion, blood transfusion group was found to be potent to increase intrahepatic metastases. But, neither inhibition nor enhancement with total occlusion of hepatic blood inflow for 20 and 30 minutes was seen. Conclusions: Surgical trauma, especially partial hepatectomy and blood transfusion, are involved in enhancing metastasis, but total occlusion of hepatic blood inflow is not responsible for enhanced liver metastasis in the experimental metastasis model.

损伤控制在Ⅲ级以上肝破裂患者救治中的应用

目的探讨损伤控制性手术在Ⅲ级以上肝破裂患者救治中的应用效果。方法回顾性分析采取损伤控制性手术治疗的24例Ⅲ级以上外伤性肝破裂患者临床资料,其中Ⅲ级9例,Ⅳ级13例,Ⅴ级2例。手术程序主要分为一期控制性手术治疗、复苏治疗、二期确定性手术治疗3个阶段。结果24例一期控制性手术治疗患者中因腹腔内压力较高使用无菌营养袋暂时关腹3例,严重肝脏多处碎裂伤留置体外可控式第一肝门阻断带2例;救治成功22例,因弥漫性血管内凝血、合并重度颅脑损伤死亡2例。重症医学科复苏治疗22例,4~8 d各种生命体征及血液化验指标基本恢复正常后施行二期确定性手术治疗,术后腹腔感染导致败血症死亡1例,死亡率为4.5%(1/22);其他并发症:胆漏3例,继发性肝脓肿2例,胸腔少量积液2例,B级胰漏1例,均通过充分引流、抗感染、营养支持等措施治愈。本组24例患者行控制性手术治疗总体成功率为87.5%(21/24),总体死亡率为12.5%(3/24)。结论采用损伤控制性手术治疗Ⅲ级以上肝破裂有利于维护患者血流动力学稳定性,逆转和纠正致死性三联征的恶性循环,提高救治成功率,降低死亡率。

复苏性主动脉球囊阻断术对肝损伤伴失血性休克后凝血功能的影响

目的长时间的复苏性主动脉球囊阻断术(REBOA)可引起缺血再灌损伤,但其对创伤后凝血功能的影响尚不明确。文中旨在探讨60 min的REBOA对创伤性凝血病(TIC)发生的影响。方法选取10头健康成年普通级、长白猪,使用实验用弹道枪构建肝穿透伤合并失血性休克模型,随机分为实验组(在主动脉1区行REBOA并阻断60 min)和对照组(在主动脉1区行REBOA但未阻断血流),每组5头。连续监测基本生命体征及血流动力学参数,并在基线点、休克点及休克后每60 min的观察点采集血样本,进行动脉血气,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)等常规凝血指标和血栓弹力图(TEG)检测。结果60 min观察点,实验组的SBP、DBP、MAP、CO、Lac、Hb明显高于对照组(P<0.05),pH、Fib和R值明显小于对照组(P<0.05)。Log-Rank检验结果显示,实验组的生存率显著高于对照组(P=0.002)。对照组休克点的PT和INR较基线点明显增加(P<0.05),Angle较基线点明显降低(P<0.05),R值较基线点、60 min观察点明显增加(P<0.05)。实验组休克点的PT和INR、R值较基线点明显增加(P<0.05),120 min及180 min的观察点PT和INR较休克点明显增加(P<0.05),60 min及180 min观察点的R值较休克点明显增加(P<0.05),血清钙离子浓度在120 min及180 min观察点明显小于休克点(P<0.05),Fib在180 min的观察点较休克点明显减少(P<0.05)。结论REBOA能有效控制肝穿透伤出血,改善并维持近端血压,提高创伤后存活率。但主动脉1区60 min的REBOA加重了酸中毒,诱发了TIC的低凝状态并导致钙离子浓度和纤维蛋白原水平降低,需谨慎实施并严密监测处理。

磁共振张量成像对闭合性隐匿肝损伤诊断价值分析

目的 探讨磁共振张量成像(Diffusion tensor imaging,DTI)对闭合性隐匿肝损伤的诊断价值。方法 回顾性分析闭合性隐匿肝损伤患者43例,分析其DTI不同时间段(48h、72h及7d)影像变化特点,平均扩散系数(average diffusion coefficient,DCavg)及各向异性系数(fractional anisotropy,FA)值、肝酶(AST/ALT)变化规律及其之间相关性。采用SPSS22.0软件进行统计分析,以P<0.05为差异有统计学意义。结果 闭合性隐匿肝损伤表现肝实质内信号不均(T_(2)WI/DTI示高信号),DTI诊断闭合性隐匿肝损伤阳性率显著高于T_(2)WI/T_(1)WI(χ^(2)=24.08,P<0.01)及AST/ALT (χ^(2)=4.49,P<0.05);DCavg(b=100、 300 s/mm^(2))于24h、48h组与对照组比较均显著性升高(P<0.05);而FA(b=100、300、600s/mm^(2))值呈下降趋势,对照组与24h、48h、7d组均存在显著性差异(P<0.05);DCavg与AST间存在高度负相关(b=100s/mm^(2),R=-0.71,P<0.01), FA与AST、ALT间均亦存在显著负相关(b=300s/mm^(2),R=-0.70,P<0.01)。结论 DTI能较早的发现闭合性肝损伤肝内隐匿性病灶,其参数Dcavg及FA客观反映闭合性隐匿肝损伤的病理变化特点,对闭合性隐匿肝损伤的准确诊断具有重要的临床价值。

急性单发性创伤性颅脑损伤术后TNF-α、LPS、IL-6、PAF、PLA2及凝血功能水平与肝功能异常的相关性

目的分析急性单发性创伤性颅脑损伤术后肿瘤坏死因子-α(TNF-α)、脂多糖(LPS)、白细胞介素-6(IL-6)、血小板活化因子(PAF)、磷脂酶A2(PLA2)及凝血功能指标与肝功能异常的相关性。方法回顾性收集2020年1月至2022年9月运城市中心医院急诊科收治的131例急性单发性创伤性颅脑损伤患者作为观察组,另选50名同期健康体检者作为对照组。依据肝功能指标将131例急性单发性创伤性颅脑损伤患者分为异常组53例和正常组78例。比较观察组术后3 d与对照组TNF-α、LPS、IL-6、PAF、PLA2、凝血功能指标[活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶原时间(PT)、凝血酶时间(TT)、血小板计数(PLT)、国际标准化比值(INR)]和肝功能指标[丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)及γ-谷氨酰基转移酶(γ-GT)]水平。采用Pearson法分析TNF-α、LPS、IL-6、PAF、PLA2、APTT、FIB、PT、TT、PLT、INR与肝功能异常的相关性。结果观察组患者TNF-α、LPS、IL-6、PAF、PLA2、APTT、PT、TT、INR、ALT、ALP、AST、TBIL和γ-GT水平均显著高于对照组,FIB、PLT水平均显著低于对照组,差异均有统计意义(P<0.05)。异常组的TNF-α、LPS、IL-6、PAF、PLA2、APTT、PT、TT、INR、ALT、ALP、AST、TBIL和γ-GT水平均显著高于正常组,FIB、PLT水平均显著低于正常组,差异均有统计意义(P<0.05)。Pearson分析发现,TNF-α、LPS、IL-6、PAF、PLA2、APTT、PT、TT、INR与ALT、ALP、AST、TBIL和γ-GT水平均呈正相关(P<0.05),FIB、PLT与ALT、ALP、AST、TBIL和γ-GT水平均呈负相关(P<0.05)。结论急性单发性创伤性颅脑损伤患者术后炎症反应、凝血功能障碍与肝功能异常有关,临床应同时监测炎症因子、凝血功能及肝功能指标,需在保肝的同时联合抗炎和纠正凝血功能障碍进行综合干预。

荧光染色对肝外胆管的保护作用在老年急性胆囊炎手术中的应用

目的:探讨荧光染色对肝外胆管的保护作用在老年急性胆囊炎手术中的应用。方法:选择2022年12月—2023年3月高安市人民医院普外科收治的老年急性胆囊炎手术患者80例为研究对象,随机数字表法分为两组,各40例。对照组术中常规采用白光辅助,观察组采用荧光染色对肝外胆管进行保护,术后7 d评估效果,比较两组显影率(胆囊管、肝总管、胆总管、右肝管)、术后胃肠功能、炎症因子、肝肾功能及术后并发症发生率。结果:观察组胆囊三角解剖后胆囊管、肝总管、胆总管及右肝管显影率均高于对照组;胆囊切除后胆囊管显影率高于对照组,肝总管、胆总管及右肝管显影率均低于对照组,差异均有统计学意义(P<0.05);观察组术后排气、肠鸣音恢复、术后排便时间均早于对照组,手术时间、术中出血量及住院时间均少于对照组,差异均有统计学意义(P<0.05);观察组手术后7 d白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(P<0.05);两组术前、手术后7 d白蛋白(ALB)水平差异均无统计学意义(P>0.05);观察组手术后7 d丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TB)、尿素氮(BUN)及肌酐(Cr)水平均低于对照组,差异均有统计学意义(P<0.05);观察组术后胆汁瘘、胆管损伤、术后再手术、肠梗阻、严重腹腔感染总发生率低于对照组,差异有统计学意义(P<0.05)。结论:荧光染色对肝外胆管能发挥良好的保护作用,能提高胆囊管、肝总管、胆总管、右肝管显影率,有助于促进患者胃肠功能恢复,降低炎症因子水平,且对患者肝肾功能影响较小,可降低术后并发症发生率。

腹腔镜手术与小切口开放手术治疗儿童胆总管囊肿的效果及对患儿胃肠功能、创伤反应的影响

目的:对比腹腔镜手术与小切口开放手术治疗儿童胆总管囊肿(CC)的效果。方法:收集2019年4月—2022年4月漯河市第二人民医院收治的100例CC患儿,按手术方案不同分为A组(n=50)和B组(n=50)。B组接受小切口CC切除术治疗,A组接受腹腔镜辅助CC切除术治疗。对比两组手术指标、胃肠功能恢复指标、肝功能指标[谷草转氨酶(AST)、总胆红素(TBIL)、谷丙转氨酶(ALT)]、创伤反应指标[皮质醇(Cor)、丙二醛(MDA)、促肾上腺皮质激素(ACTH)]水平、并发症发生率。结果:与B组相比,A组切口长度、引流管拔除时间、住院时间更短,术中失血量更少,手术时间更长,差异均有统计学意义(P<0.05);与B组相比,A组术后首次进食时间、术后首次排便时间均更短,差异均有统计学意义(P<0.05);术后1 d、3 d,两组AST、ALT、TBIL水平较术前均降低,且A组均低于B组,差异均有统计学意义(P<0.05);术后1 d、3 d,两组血清Cor、MDA、ACTH水平较术前均升高,但A组均低于B组,差异均有统计学意义(P<0.05)。A组并发症发生率为2.00%(1/50),与B组的12.00%(6/50)相比,差异无统计学意义(P>0.05)。结论:与小切口开放手术治疗CC患儿相比,应用腹腔镜辅助CC切除术治疗于优化手术指标、胃肠功能恢复指标、肝功能指标方面更具优势,且对机体创伤反应影响更小,但手术时间略长。

经导管栓塞治疗肝脏外伤出血

目的探讨经导管栓塞治疗肝脏外伤出血的疗效、适应证、并发症等。方法回顾性分析我院从1996年5月到2006年5月收治肝脏外伤出血患者33例,其中24例行肝动脉造影证实为肝动脉假性动脉瘤形成,再超选择插管至病变部位,根据载瘤动脉受损情况,予明胶海绵和(或)弹簧圈栓塞。结果24例28枚假性动脉瘤栓塞技术上均一次成功。2例分别在栓塞后48h、72h再次出血。再次栓塞后1例康复,1例在第2次栓塞后1周因再出血和严重腹腔感染死亡。发热9例,均与栓塞无直接相关。结论经导管栓塞治疗肝脏外伤出血安全、迅速、有效。

超声造影引导微波凝固治疗Ⅰ～Ⅲ级肝外伤的实验研究

目的探讨超声造影引导微波凝固治疗Ⅰ～Ⅲ级肝外伤伴活动性出血的应用价值。方法全麻开腹状态下10只肝素化小型猪共建立Ⅰ～Ⅲ级肝外伤伴活动性出血模型40处，超声造影引导下将微波电极植入肝内活动性出血部位进行微波凝固治疗。治疗后2h观察治疗区有无再出血和血肿，并行超声造影检查及组织病理学检查判断疗效。结果40处肝外伤伴活动性出血微波治疗后均成功控制出血，Ⅱ级和Ⅲ级肝外伤局部出血时间[（192．0±108．0）S和（443．4±63．5）s]均长于Ⅰ级肝外伤[（48．3±33．3）s]（P〈0．01），出血量[（24．8±6．5）g和（47．8±10．5）g]均大于Ⅰ级肝外伤[（6．6±4．3）g]（P〈0．01）。微波治疗后2小时局部肝被膜均未见活动性出血和血肿。灰阶超声造影显示9处Ⅱ级和5处Ⅲ级肝外伤治疗区仅周边部见少许走行规则的线状增强，余治疗区均未见增强，呈负性显影。组织病理学显示，Ⅰ～Ⅲ级肝外伤微波治疗区内肝细胞变性明显，肝小叶内见多个大小不等的腔隙；血管壁的退变以近针道区明显，而远离针道区变化不明显。结论超声造影引导微波凝固治疗对Ⅰ～Ⅲ级肝外伤伴活动性出血较好的治疗作用，有望成为临床上外科治疗的一种重要辅助方法。

胶原海绵止血功能的实验研究

目的 验证国产胶原海绵的止血性能。方法 选用健康成年 SD大鼠 2 0只 ,随机分为二组。行肝脏表浅切口 ,分别用胶原及明胶海绵止血 ,观察止血情况 ;切除肝左前叶造成标准肝创伤模型 ,分别用二种海绵止血 ,观察止血情况 ,并记录即时止血时间及出血量。术后 7、14及 2 0天剖腹观察腹腔内粘连、腹腔内感染及肝脏愈合情况 ,并切除部分再生肝组织进行组织学检查。结果 胶原海绵与肝创面粘附良好 ,即时止血时间及出血量均明显优于对照组 (P<0 .0 5 )。组织切片显示胶原海绵吸收、降解快 ,可诱导肝细胞再生。结论 胶原海绵止血性能良好 ,能有效诱导肝再生 ,吸收降解快 ,使用方便 ,有应用、推广价值。