腹腔镜下修补术联合肝动脉介入栓塞术治疗外伤性肝破裂的效果及术后并发症的危险因素  

Efficacy of Laparoscopic Repair and Hepatic Artery Embolization in the Treatment ofTraumatic Liver Rupture and Risk Factors for Postoperative Complication

作　　者：李训海[1] 李炯[1] 曹淑洋 吴继君[1] LI Xunhai;LI Jiong;CAO Shuyang;WU Jijun(Department of General Surgery,Zhengzhou First People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第一人民医院普外科,河南郑州450000

出　　处：《河南医学研究》2023年第16期2971-2974,共4页Henan Medical Research

摘　　要：目的探讨腹腔镜下修补术与肺动脉介入栓塞术(TAE)治疗外伤性肝破裂的效果,并分析术后并发症的危险因素。方法选取2018年6月至2021年12月在郑州市第一人民医院诊治的104例外伤性肝破裂患者,按照治疗方式分为对照组(腹腔镜下修补术)51例和研究组(腹腔镜下修补术联合TAE)53例,比较两组围手术期指标、并发症发生情况,以及术后并发症的影响因素。结果与对照组比较,研究组饮食恢复时间、凝血酶原时间(PT)和活化部分凝血促凝血酶原时间(APTT)恢复时间、体温恢复时间、乳酸清除时间、住院时间较短,有效止血率较高,并发症发生率较低(P<0.05)。104例外伤性肝破裂患者有18例术后发生并发症,经多因素二元logistic分析,损伤Ⅱ级、损伤Ⅴ级、腹腔镜下修补术、手术时间≥4 h、白细胞数高是术后并发症发生的的危险因素(P<0.05)。结论腹腔镜下修补术联合TAE治疗外伤性肝破裂,可有效缩短治疗和恢复时间,减少并发症的发生。外伤性肝破裂需尽量选取腹腔镜下修补术联合TAE治疗,对于损伤级别高、手术时间长、白细胞数高患者,需给予有效干预措施以减少术后并发症的发生。Objective To investigate the efficacy of laparoscopic repair and hepatic artery embolization(TAE)in the treatment of traumatic liver rupture,and to analyze the risk factors for postoperative complications.Methods A total of 104 patients with traumatic liver rupture who were diagnosed and treated in Zhengzhou First People’s Hospital from June 2018 to December 2021 were selected and divided into control group(laparoscopic repair)51 cases and study group(laparoscopic repair combined with TAE)53 cases according to treatment methods.Repair,the perioperative indicators,complications,and the influencing factors of postoperative complications were compared between the two groups.Results Compared with the control group,the diet recovery time,prothrombin time(PT)and activated partial thromboplastin time(APTT)recovery time,body temperature recovery time,lactate clearance time,hospital stay were shorter,the effective hemostasis rate was higher,and the incidence of complications rates were lower in the study group(P<0.05).Postoperative complications occurred in 18 out of 104 patients with traumatic liver rupture.After multivariate binary logistic analysis,injury gradeⅡ,injury grade V,laparoscopic repair,operation time≥4 hours,and high white blood cells were the risk factors for postoperative complications(P<0.05).Conclusion Laparoscopic repair combined with TAE in the treatment of traumatic liver rupture can effectively shorten the treatment and recovery time,reduce complications.Traumatic liver rupture should be treated with laparoscopic repair combined with TAE as much as possible.For patients with high injury grade,long operation time,and high WBC,effective intervention measures should be given to reduce the occurrence of postoperative complication.

关 键 词：腹腔镜下修补术 肺动脉介入栓塞术 外伤性肝破裂 并发症 

分 类 号：R657.3[医药卫生—外科学]