摘要
目的探究左侧卧位腹腔镜手术处理肝右后叶外伤的可行性及安全性。方法回顾性分析右江民族医学院附属医院肝胆外科2016年2月至2020年8月期间采用左侧卧位腹腔镜手术治疗的肝右后叶外伤患者的临床资料,分别记录和分析性别、年龄、致伤原因、手术方式、手术时间、腹腔积血量、肝损伤分级、术中出血量、术后引流量、术后住院时间、主要并发症等。结果共纳入18例患者,其中男性16例,女性2例,年龄(41.6±14.4)岁。高处坠落伤10例,车祸伤4例,重物砸伤2例,穿刺性损伤2例。Ⅲ级损伤16例,Ⅳ级损伤2例。腹腔镜下缝合修补术8例,肝部分切除术4例,单纯电凝止血4例,出血血管结扎2例,手术均获得成功。术中发现腹腔积血量(1528.8±373.2)ml,术中出血量(80.6±16.7)ml,手术时间(88.5±9.1)min,术后中位住院时间7 d,术后总引流量(93.8±13.6)ml。并发右侧胸腔积液10例,经保守治疗后恢复,无胆漏,无感染等并发症。结论左侧卧位腹腔镜处理肝右后叶外伤具有暴露好、修复方便、二次损伤小、住院时间短等优点,可行性及安全性较好。
Objective To study the feasibility and safety in treatment of trauma to right posterior liver using laparoscopic surgery with patients in the left semiprone position.Methods The clinical data of consecutive patients who were diagnosed to have trauma to the right posterior liver and were treated with laparoscopic surgery with patients in the left semiprone position at the Department of Hepatobiliary Surgery,the Affiliated Hospital of Youjiang Medical University for Nationalities between February 2016 and August 2020 were retrospectively analysed.The patients’gender,age,mechanisms of injury,operative methods,operative time,amounts of abdominal effusion,degrees of liver injury,extents of intraoperative bleeding,amounts of postoperative drainage,lengths of postoperative hospital stay,and major postoperative complications were recorded and analyzed.Results Among the 18 patients,there were 16 males and 2 females,aged(41.6±14.4)years.The mechanisms of liver trauma were caused by fall injury(n=10),traffic accidents(n=4),blunt injury(n=2)and penetrating injury(n=2).The levels of injuries were levelⅢin 16 patients and levelⅣin 2 patients.Laparoscopic suture repair was performed in 8 patients,partial hepatectomy in 4 patients,electrocoagulation hemostasis in 4 patients and ligation of bleeding vessels in 2 patients.All were successful in hemostasis.Abdominal effusion was(1528.8±373.2)ml,intraoperative blood loss(80.6±16.7)ml,operation time(88.5±9.1)min,postoperative hospital stay 7 days and postoperative total drainage(93.8±13.6)ml.Ten patients were complicated with right pleural effusion,and they recovered with conservative treatment.There were no bile leakage,infection and other complications.Conclusion Trauma to right posterior liver treated with laparoscopic with surgery patients in the left semiprone position had the advantages of adequate exposure which facilitated surgical hemostasis,resulting in minimal collateral damages and short hospital stay.The treatment was feasibility and safe.
作者
陆礼柏
汪伟
陈鹏宇
姚天尉
罗宗将
李文川
浦涧
唐乾利
汪建初
Lu Libai;Wang Wei;Chen Pengyu;Yao Tianwei;Luo Zongjiang;Li Wenchuan;Pu Jian;Tang Qianli;Wang Jianchu(Department of Hepatobiliary Surgery,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi Province,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第8期566-569,共4页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金(82060441)
广西自然科学基金(2019JJA140524)
广西特聘专家专项资助(桂人才通字(2019)13号)
广西科技计划项目(桂科AD17129025)
右江民族医学院附属医院第一批高层次人才项目(R20196302)
右江民族医学院附属医院博士生导师培育项目(右医附院院字201832)。
关键词
创伤和损伤
肝
腹腔镜检查
左侧卧位
Wounds and injuries
Liver
Laparoscopy
Left semiprone position
