CAJ | 학술논문

目的探讨清创性肝切除联合选择性入肝血流阻断对严重肝外伤手术治疗价值.方法总结清创性肝切除术联合选择性入肝血流阻断治疗严重肝外伤55例的临床病例资料,其中肝外伤Ⅲ级20例,Ⅳ级20例,Ⅴ级15例,伴肝周大血管损伤14例,合并其他伤35例.附加手术:肝间断缝合修补术7例,肝周纱布填塞3例,下腔静脉修补术5例,肝静脉修补术5例,肝静脉缝扎术4例,肝固有动脉结扎2例.其余患者开颅清创3例,胆囊切除6例,胆总管T管引流4例,脾切除术5例,胰体尾部切除2例,左肾切除术1例,胸腔闭式引流9例,小肠部分切除或修补4例,胃修补1例.结果全组救治成功47例.术后并发症19例(34.5％),其中凝血功能障碍1例,腹腔内出血2例,肠梗阻1例,肝、肾功能不全4例,腹腔感染3例,伤口感染2例,肺部感染4例,胸腔积液10例,均经治疗痊愈出院.死亡8例(14.5％),死亡原因:失血性休克3例,重型颅脑伤1例；重型颅脑伤合并胃、小肠多处破裂1例,感染性休克1例,多器官功能衰竭2例.结论清创性肝切除联合选择性入肝血流阻断是严重肝外伤手术救治的较好方法.
목적 탐토청창성간절제연합선택성입간혈류조단대엄중간외상수술치료개치.방법 총결청창성간절제술연합선택성입간혈류조단치료엄중간외상55례적림상병례자료,기중간외상Ⅲ급20례,Ⅳ급20례,Ⅴ급15례,반간주대혈관손상14례,합병기타상35례.부가수술:간간단봉합수보술7례,간주사포전새3례,하강정맥수보술5례,간정맥수보술5례,간정맥봉찰술4례,간고유동맥결찰2례.기여환자개로청창3례,담낭절제6례,담총관T관인류4례,비절제술5례,이체미부절제2례,좌신절제술1례,흉강폐식인류9례,소장부분절제혹수보4례,위수보1례.결과 전조구치성공47례.술후병발증19례(34.5％),기중응혈공능장애1례,복강내출혈2례,장경조1례,간、신공능불전4례,복강감염3례,상구감염2례,폐부감염4례,흉강적액10례,균경치료전유출원.사망8례(14.5％),사망원인:실혈성휴극3례,중형로뇌상1례；중형로뇌상합병위、소장다처파렬1례,감염성휴극1례,다기관공능쇠갈2례.결론 청창성간절제연합선택성입간혈류조단시엄중간외상수술구치적교호방법.
Objective To evaluate the effect of debridement hepatectomy with selective hepatopetal blood occlusion in the treatment of severe hepatic trauma.Methods The clinical data of 55 patients with severe hepatic trauma treated by debridement hepatectomy with selective hepatopetal blood occlusion were retrospectively analyzed.20,20 and 15 patients were with grade Ⅲ,Ⅳ and Ⅴ hepatic trauma respectively,combined with major peripheral hepatic vascular injury in 14 cases and with other trauma in 35 cases.Additional procedures including liver suture repair in 7 cases,perihepatic gauze packing in 3 cases,inferior vena cava repair in 5 cases,hepatic vein repair in 4 cases,hepatic vein ligation in 3 cases and hepatic artery ligation in 2 cases were performed.Other operations such as craniotomy debridement in 3 cases,cholecystectomy in 6 cases,T tube drainage of common bile duct in 4 cases,splenectomy in 5 cases,pancreatic tail resection in 2 cases,left kidney resection in 1 case,thoracic cavity closed drainage in 9 cases,partial small bowel resection or repair in 4 cases and stomach repair in 1 case were performed as needed.Results The operations were successful in 47 patients.Postoperative complications were observed in 19 cases (34.5％) including coagulation disorders in 1 case,postoperative abdominal bleeding in 2 cases,intestinal obstruction in 1 case,liver and renal dysfunction in 4 cases,abdominal infection in 3 cases,incision infection in 2 cases,pulmonary infection in 4 cases,pleural effuion in 10 cases.Death occurred in 8 patients (14.5％),the cause of death were hemorrhagic shock in 3 cases,combined with severe craniocerebral injury in 2 cases,septic shock in one case,and multiple organ failure in 2 cases.Conclusions Debridement hepatectomy with slective hepatopetal blood occlusion is an effective treatment for severe hepatic trauma.