中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2015年
4期
321-323
,共3页
腹腔镜%肝破裂
腹腔鏡%肝破裂
복강경%간파렬
Laparoscopy%Liver rupture
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。
目的：探討腹腔鏡下肝破裂手術的可行性及臨床療效。方法我院2012年6月～2014年4月對62例外傷性肝破裂腹腔鏡下採用電凝止血，止血紗佈填塞，破裂口縫閤止血，結扎肝動脈，清創性肝切除。結果56例順利完成腹腔鏡下手術，手術成功率90．3％（56／62）。6例因齣血過多，且難以在短時間內尋找到齣血點而中轉開腹，其中肝損傷Ⅲ級2例、Ⅳ級3例、Ⅴ級1例。Ⅰ、Ⅱ級患者均腹腔鏡下完成手術，無中轉開腹。Ⅲ級患者1例髮生膽漏；Ⅳ級患者1例髮生膽漏，1例髮生梗阻性黃疸；Ⅴ級患者1例髮生全身多器官功能障礙緻死亡，1例髮生膽道齣血，併髮癥患者經積極對癥治療後順利齣院，併髮癥髮生率8．1％（5／62），病死率1．6％（1／62）。所有患者術後隨訪3箇月，恢複良好。結論對于Ⅰ～Ⅲ級肝破裂腹腔鏡下手術是安全可行的，對于Ⅳ、Ⅴ級肝損傷，由于患者損傷較重，中轉開腹和術後髮生併髮癥的幾率增大，建議首選開腹手術。
목적：탐토복강경하간파렬수술적가행성급림상료효。방법아원2012년6월～2014년4월대62예외상성간파렬복강경하채용전응지혈，지혈사포전새，파렬구봉합지혈，결찰간동맥，청창성간절제。결과56례순리완성복강경하수술，수술성공솔90．3％（56／62）。6례인출혈과다，차난이재단시간내심조도출혈점이중전개복，기중간손상Ⅲ급2례、Ⅳ급3례、Ⅴ급1례。Ⅰ、Ⅱ급환자균복강경하완성수술，무중전개복。Ⅲ급환자1례발생담루；Ⅳ급환자1례발생담루，1례발생경조성황달；Ⅴ급환자1례발생전신다기관공능장애치사망，1례발생담도출혈，병발증환자경적겁대증치료후순리출원，병발증발생솔8．1％（5／62），병사솔1．6％（1／62）。소유환자술후수방3개월，회복량호。결론대우Ⅰ～Ⅲ급간파렬복강경하수술시안전가행적，대우Ⅳ、Ⅴ급간손상，유우환자손상교중，중전개복화술후발생병발증적궤솔증대，건의수선개복수술。
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 Ⅲliver rupture , 3 cases of grade Ⅳ, and 1 case of grade Ⅴ.Patients with liver rupture of grade Ⅰ and Ⅱwere all operated without conversions to laparotomy .One patient with grade Ⅲwas 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, andⅢliver rupture , laparoscopic surgery is safe and feasible .But for grade Ⅳand Ⅴpatients, laparoscopic surgery bears high rates of converting to open operation and postoperative complications , so we suggest open surgery as the first choice .
