腹腔镜微创手术在肝外伤临床处理中应用  

Clinical study for the efficacy of the laparoscopic microinvasive surgery for treatment of liver trauma

作　　者：刘竞[1] 张志明[1] 许邦文[1] 童艳春[1] 杨世忠[1] 钱鑫[1] 

机构地区：[1]北京军区总医院第二六三临床部普通外科,北京101149

出　　处：《中华医学杂志》2015年第28期2294-2296,共3页National Medical Journal of China

摘　　要：目的 总结腹腔镜微创手术在治疗肝外伤中的应用经验.方法 回顾性分析2009年1月至2014年3月,北京军区总医院第二六三临床部应用腹腔镜手术治疗肝外伤32例的临床资料.男21例,女11例.年龄17 ～ 60岁,平均33.7岁.闭合性损伤23例,开放性损伤9例.复合性肝外伤7例.致伤原因为撞击挤压伤13例、坠落伤10例及锐器伤9例.结果 32例腹腔镜肝手术患者.根据Moore分级标准：Ⅰ级2例,Ⅱ级7例,Ⅲ级19例,Ⅳ级4例.32例在腹腔镜下分别采用电凝止血、喷止血胶加可吸收止血纱布填塞法5例,肝缝合修补术20例,清创性部分肝切除术7例.如伴有其他脏器损伤,术中同时在腹腔镜下完成.手术时间30～210 min,平均85 min.无死亡病例.结论 正确地选择适应证,并有熟练地腹腔镜下肝脏切除技术做保障,腹腔镜微创手术是治疗肝外伤安全有效的方法.Objective To explore the laparoscopic surgery efficacy for the treatment of liver trauma.Methods From January 2009 to March 2014.32 patients were received laparoscopic surgery for liver trauma treated in our hospital.There were 21 males and 1 1 females with an average age of 33.7 years old.Among the group,23 cases were closed abdominal injury,9 cases were open injury.7 cases were Combined organ injuries.The patients＇ injuries arose from various causes,13 due to falling,10 due to be crushed,and 9 due to be cut.Results 32 patients were treated with laparoscopy completely.According Moore Classification standards.2 cases were type Ⅰ,7 cases type Ⅱ,19 cases type Ⅲ,4 case type Ⅳ.32 cases underwent electric coagulation,laparoscopic fibrin glue and soluble hemostatic gauze packing（n =5）,sutures to the broken liver（n =20）,debridement partial hepatectomy（n =7）.The patients combined with other organ injury were treated with laparoscope simultaneously.The operative duration time were 85 （30-210）mins.There was no postoperative death.Conclusion Correct selection of indication and a deft laparoscopic liver resection help guarantee the laparoscopic surgery to be applicable way in treatment liver trauma.

关 键 词：肝外伤 腹腔镜手术 

分 类 号：R657.3[医药卫生—外科学]