可吸收网片治疗重度肝外伤实验探究.docVIP

可吸收网片治疗重度肝外伤实验探究 　【摘要】 评价网套捆扎术在Ⅲ～Ⅳ级肝损伤处理中的效果和临床意义。方法 14只荷兰猪制作成Ⅲ～Ⅳ级肝损伤模型后分成两组，实验组以网套捆扎止血，对照组关腹，术后处理一致。分别测术前、术后、术后24 h、7天、14天存活动物肝功能，术中测肝内三点压力，14天后采取存活动物肝脏行大体观察及组织学检查。结果 实验组有较为满意的生存率及并发症发生率。结论 该术式能够促进肝损伤的良好愈合，疗效确切，简便易行，适合临床推广。 【关键词】 重度肝外伤 网套捆扎术 可吸收网片 Study on surgical treatment of liver injury with an absorbable mesh JIN Ning，LUO Min-sheng，CHEN Dong，et al.Department of Surgery，Xili Hospital，Shenzhen 518055，China ［Abstract］ Objective To evaluate the effect on the clinical treatment of severe liver injury in grade Ⅲ～Ⅳ according to the Liver Injury Scale of the American Association for the Surgery of Trauma with an absorbable mesh.Methods 14 Dutch pigs produced into the model of liver injury in grade Ⅲ～IV were divided into two groups.In test group，the injured lobe was wrapped with a polyglycolic acid （Vicryl） mesh.In control group，the abdominal wall was closed after the injury was made，the postoperative managements were the same.Before and immediately after the operative procedure，liver function tests were performed on all animals.These were also done in 24 hours，7 days，and 14 days postoperative in the surviving animals.Intrahepatic pressures were measured at three standardized locations in the wrapped lobe.The livers of the treated animals were harvested for gross and microscopic examinations at the 14th postoperative day.Results The survival rate and complication rate in test group were satisfactory.Conclusion It can be stated that the application of this type of a mesh wrap is a relatively simple and quick procedure.It can promote a good healing in liver injury.We recommend it as a standard treatment for severe hepatic injury. ［Key words］ severe liver injury;mesh wrapping;absorbable mesh 在Ⅲ～Ⅳ级肝实质挫伤的手术处理中，经过结扎动静脉血管及创面组织缝扎处理后，实质深部的出血常常难以控制，广泛的肝缝合术，肝段或肝叶切除术，常因大块缝扎引致坏死，切除时过多的顾虑及手术耗时过长，创面较大，术后并发症增多等原因存在某种程度的缺憾。大块的包裹及填塞能对大多数肝实质严重挫伤的病例起到短暂的控制出血作用，留置24～96 h的肝周填塞作为这种处理中常用的手段，同时亦存在着一些严重的缺陷，如患者刚进入稳定期后的再次手术；取出填塞物后再出血所需的再填塞；25％的脓毒血症或脓肿形成的发生率；对呼吸及肠道、肾脏及腹内压可能造成的不利影响等。可吸收网片的使用在