目的

探讨以“指捏法切肝”为核心技术的全流程管理在累及肝静脉主干的严重肝外伤中的应用。

方法

回顾性分析2017 年1 月至2023 年7 月在郴州市第一人民医院收治的18 例累及肝静脉主干的严重肝外伤患者临床资料。患者和（或）家属均签署知情同意书，符合医学伦理学规定。其中男10 例，女8 例；年龄2.5～65.0 岁，中位年龄32.5 岁。根据美国创伤协会（AAST）肝外伤分级，均为Ⅴ级肝外伤。采用术前、术中及术后规范化全流程管理，术前快速完善准备，术中采用指捏法切肝，纱布填塞止血，主刀医师与一助协调配合，下腔静脉破裂及肝静脉主干破裂用无损伤血管缝线行修补缝合。观察患者围手术期情况及疗效。

结果

救治成功16 例，其中腹部手术一次完成者11 例，余5 例根据损伤控制性理论行纱布填塞后再次或多次手术取出纱布，救治成功率为89%（16/18）。2 例死亡，其中1 例为8 岁幼年男性，术中因下腔静脉大出血、空气栓塞死亡；另1 例为2.5 岁幼年女性，术中因失血过多致死。切肝时间 5～30 min，中位切肝时间20 min。16 例患者均顺利恢复出院。

结论

对于累及肝静脉主干的严重肝外伤患者，采用以“指捏法切肝”为核心技术的全流程管理，可明显提高救治成功率。

Objective

To investigate the application of full-process management with finger-pinching hepatectomy as the core technology in severe liver trauma involving hepatic vein trunk.

Methods

Clinical data of 18 patients with severe liver trauma involving hepatic vein trunk admitted to the First People's Hospital of Chenzhou from January 2017 to July 2023 were retrospectively analyzed.The informed consents of all patients and/or their family members were obtained and the local ethical committee approval was received.Among them, 10 patients were male and 8 female, aged from 2.5 to 65.0 years, with a median age of 32.5 years.According to the American Association for the Surgery of Trauma (AAST) grading scale, all patients were classified as grade Ⅴ liver trauma.Standardized full-process management was adopted before, during and after surgery.Preoperative preparations were rapidly made.Intraoperatively, liver resection was performed by finger pinching, gauze packing was used to stop bleeding, chief surgeon coordinated with the assistant surgeon to repair and suture the inferior vena cava rupture and hepatic vein trunk rupture using atraumatic sutures.Perioperative status and efficacy of all patients were observed.

Results

16 cases were successfully treated, including 11 cases undergoing once abdominal surgery at one time and the remaining 5 cases were treated with gauze packing according to the theory of damage control surgery and then the gauze was taken out by secondary or multiple surgeries.The treatment success rate reached 89%(16/18).2 cases died.One 8-year-old boy died from intraoperative massive hemorrhage of the inferior vena cava and air embolism.Another 2.5-year-old girl died from excessive blood loss during surgery.The liver resection time was ranged from 5 to 30 min, and the median liver resection time was 20 min.The remaining 16 patients were discharged smoothly.

Conclusions

For patients with severe liver trauma involving hepatic vein trunk,the full-process management with ＂finger-pinching hepatectomy＂ as the core technology can significantly improve the treatment success rate.