解剖性肝切除在小儿严重肝外伤中的应用价值

doi:10.3877/cma.j.issn.2095-3232.2015.01.006

中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (01) : 21 -23. doi: 10.3877/cma.j.issn.2095-3232.2015.01.006

所属专题：文献；

临床研究

解剖性肝切除在小儿严重肝外伤中的应用价值

刘昌军¹, 黄飞舟¹^,^†(

), 刘初平¹, 沈贤波¹, 杨尽晖¹, 蒋波¹, 吴金术¹

^1. 410005　长沙，湖南师范大学第一附属医院　湖南省人民医院肝胆外科

收稿日期:2014-08-07 出版日期:2015-02-10
通信作者: 黄飞舟
基金资助:
湖南省科技计划资助项目(2013SK3194)

Application value of anatomical hepatectomy for children with severe liver trauma

Changjun Liu¹, Feizhou Huang¹^,^†(), Chuping Liu¹, Xianbo Shen¹, Jinhui Yang¹, Bo Jiang¹, Jinshu Wu¹

^1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan People's Hospital, Changsha 410005, China

Received:2014-08-07 Published:2015-02-10
Corresponding author: Feizhou Huang
About author:
Corresponding author: Huang Feizhou, Email:18975186183@163.com

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目的

探讨解剖性肝切除在小儿严重肝外伤中的应用价值。

方法

回顾性分析2010年1月至2013年1月在湖南师范大学第一附属医院行解剖性肝切除的11例严重肝外伤患者临床资料。其中男7例，女4例；年龄1～12岁，中位年龄7岁。所有患者均签署知情同意书，符合医学伦理学规定。患者在区域性肝门阻断下行解剖性肝切除术。观察患者术中及术后情况，包括手术时间、术中出血量、围手术期并发症发生情况。

结果

11例患者均成功行解剖性肝切除术。其中肝Ⅳb段切除1例，肝左外叶切除2例，左半肝切除1例，肝Ⅵ段切除2例，肝Ⅷ段切除1例，肝右后叶切除1例，右半肝切除3例。其中1例合并肝后下腔静脉损伤患者行解剖性右半肝切除后下腔静脉修补成功；3例合并脾破裂行脾切除术；5例胆道损伤患者行术中修补及胆总管引流。手术时间中位数为3（1～8）h，术中出血量为50（5～600）ml。术后发生胆漏1例，膈下感染合并肺部感染、败血症1例，均予对症处理后治愈。

结论

解剖性肝切除是治疗小儿严重肝外伤安全、有效的方法。

关键词: 肝切除术, 腹部损伤, 儿童

Objective

To explore the application value of anatomical hepatectomy for children with severe liver trauma.

Methods

Clinical data of 11 patients with severe liver trauma in the First Affiliated Hospital of Hunan Normal University from January 2010 to January 2013 were retrospectively analyzed. There were 7 males, 4 females with the age ranging from 1 to 12 years old and the median of 7 years old. The informed consents of all patients were obtained and local ethical committee approval had been received. The patients underwent anatomical hepatectomy with regional hepatic portal occlusion. The intraoperative and postoperative situation including operation time, intraoperative blood loss and perioperative complications were observed.

Results

All the 11 cases underwent anatomical hepatectomy successfully. The operations included segment Ⅳb hepatectomy (n=1), left lateral lobectomy (n=2), left hemihepatectomy (n=1), segment Ⅵ hepatectomy (n=2), segment Ⅷ hepatectomy (n=1), right posterior lobectomy (n=1), right hemihepatectomy (n=3). One of the cases combined with posthepatic inferior vena cava injury underwent inferior vena cava repair successfully after anatomical right hemihepatectomy. Three cases complicated with spleen rupture underwent splenectomy. Five cases with biliary injury underwent repair and drainage during the operation. The median operation time was 3(1-8) h. The intraoperative blood loss was 50(5-600) ml. One case suffered from bile leakage after operation, and 1 cases suffered from subphrenic infection and pulmonary infection, septicemia. All recovered after symptomatic treatments.

Conclusion

Anatomical hepatectomy is a safe and effective method for children with severe liver trauma.

Key words: Hepatectomy, Abdominal injury, Child

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