绕肝提拉法前入路右半肝切除术在严重钝性肝外伤中的应用  

Anterior approach for right hepatectomy using liver hanging maneuver in severe blunt liver trauma

作　　者：陈庆永[1] 陈立波[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院急诊外科,武汉430022

出　　处：《中华普通外科杂志》2017年第5期410-414,共5页Chinese Journal of General Surgery

摘　　要：目的探讨绕肝提拉法前入路有半肝切除术在严重钝性肝外伤中的应用价值。方法回顾性分析华中科技大学同济医学院附属协和医院2011年1月至2017年1月行有半肝切除术治疗的严重肝外伤患者63例的临床资料，其中行绕肝提拉法前入路右半肝切除术31例（前入路组），传统入路有半肝切除术32例（传统入路组），比较两组患者的临床资料、术中出血量、术后肝功能损害、术后并发症发生率及死亡率等各项指标。结果本组死亡8例（12．7％），其中前入路组1例（1／31，3．2％），传统入路组7例（7／32，21．9％）。前入路组31例患者均成功行绕肝提拉法前入路右半肝切除术，前入路组患者术中出血量较传统入路组术中出血量明显减少（768±231）ml比（1264±1248）ml（P〈0．05），前入路组患者术后第3天肝功能丙氨酸氨基转移酶（alanine transaminase，ALT）值较传统入路组明显减少（155±89）U／L比（689±67）U／L（P〈0．05），且前入路组患者的术后并发症发生率及死亡率较传统入路组患者的术后并发症发生率及死亡率均明显降低（12．9％比34．4％，3．2％比21．9％，均P〈0．05）。结论绕肝提拉法前入路右半肝切除术是治疗严重肝外伤安全、有效的方法．具有减少术中出血量、减轻术后肝功能损害、降低术后并发症及死亡率等优势。Objective To evaluate the application value of anterior approach right hepateetomy using the liver hanging maneuver for severe blunt liver trauma. Methods Clinical data of 63 patients with severe blunt liver trauma undergoing right hepateetomy in our hospital from January 2011 to January 2017 were retrospectively analyzed. Among them, 31 patients received anterior approach right hepateetomy （anterior approach group, 31 eases） while the others did conventional right hepatectomy （conventional approach group , 32 cases）. Clinical data, intraoperative blood loss, postoperative alanine transaminase （ALT） at POD3, postoperative morbidity and mortality in both groups were analyzed and compared. Results There were eight surgical deaths, one in the anterior approach group and seven in the conventional approach group. All the 31 eases underwent anterior approach right hepatectomy successfully using the liver hanging maneuver. The mean intraoperative blood loss （ 768 ± 231 ） ml vs. （ 1 264 ± 1 248 ） ml （ P 〈 0. 05 ）, postoperative hepatic function ALT value at POD3 （ 155 ± 89 ） U/L vs. （ 689± 67 ） U/L （ P 〈 0. 05 ）, postoperative morbidity and mortality of the anterior approach group were markedly superior to conventional approach group （ 12.9% vs. 34.4% , 3.2% vs. 21.9% , all P 〈 0.05） . Conclusions Anterior approach right hepatectomy using the liver hanging maneuver has advantages of decreased intraoperative blood loss, less hepatic function compromise, reduced postoperative morbidity and mortality compared to conventional approach right hcpatectomy in cases of severe right liver blunt trauma.

关 键 词：创伤和损伤 肝切除术 绕肝提拉法 肝后隧道 

分 类 号：R657.3[医药卫生—外科学]