Hepatic injury Treatment
Hepatic injury (liver injury) should early surgical treatment after confirmed diagnosis, the wounded are mostly internal bleeding and hemorrhagic shock, and some also with other organ damage. Preoperative antishock processing is very important, can damage the high-casualty anesthesia and surgery on tolerance. Should first establish a reliable and effective means of blood transfusion, select branches of the superior vena cava blood transfusion as a more appropriate way, because of some trauma with laceration of inferior vena cava, from the lower limb may be delayed or leakage of blood transfusion, not to add the effect of blood volume. Some of severe liver trauma with major blood vessels rupture, hemorrhage volume is very large, despite a large number of positive blood transfusion has yet to enable rapid recovery and stable blood pressure. Should stepping up the anti-shock treatment section at the same time, control of active bleeding, if shock further improved then should the next surgery.
The principle of surgical treatment of liver injury is complete hemostasis, removal of the fragmentation in liver tissue and placement of peritoneal abteilung in order to prevent secondary infection. Hemostasis is the crux of Hepatic injury treatment, whether effective control of bleeding can directly affect the mortality rate of Hepatic injury. The lost vitality fragmentation of liver tissue is necrosis decomposition, accumulation of both blood and bile will eventually formed secondary infection and lead to intra-abdominal abscess.
The treatment of liver laceration true: stop bleeding, bleeding more can be blocked when the liver pedicle and then based on the specific circumstances to choice the following method:
1. Simple suture: the rules apply to the linear liver laceration. Generally No. 4-0 No. 1-0 silk or catgut to wear for long and thin needle through the circle at the end of Year "8" shaped or mattress suture. Ligation, when forced to be lightweight and soft to prevent the suture cutting liver tissue. The eye of a needle if there is bleeding, can be oppressive heat saline gauze to stop bleeding.
2. Debridement: large and deep wounds of the liver laceration, loss of vitality should be to remove the liver tissue, blood vessels to wounds or stump bile duct ligation 11, reduced inflow organizations active bleeding point can be used for "8" hemostatic suturing characters. Upon completion of hemostasis, such as the liver wound closure in the deep dead space left for those who simply should not be combined, can be opened with a pedicled omental coverage or will be embedded in the retina of the elimination of dead space and then combined, and placed drainage.
3. Hepatic artery ligation: According to the above-mentioned methods can not be effective to stop bleeding may be taken into account hepatic artery ligation or hepatic artery side branch injury. Bleeding from the hepatic artery may be a good hemostatic effect.
4. Hepatectomy: a serious fragmentation of the hemorrhage-induced liver injury often difficult to control, can be used to remove non-hepatectomy liver tissue vitality to complete hemostasis. Generally do not have to partition according to the anatomy of hepatic resection line rules. According to the specific circumstances of the use of tourniquet, liver pinch clamp or hand method to control bleeding, removal of non-viability of the liver tissue, blood vessels and cut the bile duct ligation, respectively, with pedicled omental coverage or adjacent liver ligament section, and finally drainage placement.
5. Tamponade hemostasis: When using suture, hepatic artery ligation, hot saline gauze pads but still more extensive oozing or bleeding, can use large pieces of gelatin sponge, powder, soluble hemostatic gauze to fill into the wound to oppression hemostasis, such as . Not been able to stop bleeding, such as satisfaction, you can fill in large pressure gauze or gauze pad to stop bleeding. After the use of preventive antibiotics and hemostat, to be in stable condition 3 to 5 days in the operating room at times to remove the gauze pad or gauze. Packing to stop bleeding is a contingency approach, only to stop bleeding in a variety of measures to use is invalid due to secondary infection it easy bleeding or secondary severe complications such as biliary fistula.
Treatment for subcapsular hematoma of the liver injury: the majority of the liver tissue due to injury to continue to hemorrhage, liver capsule increasing tension, an end to the coated surface to expand or spin-off perforation. Surgical incision should be coated to remove blood, ligation or suturing bleeding point, and cleft suture wounds, drainage placement.
Treatment for Central Hepatic injury: This injury and the shallow hepatic parenchymal are good condition. Exploratory surgery found increased liver size, increased tension envelope should be suspected rupture of the liver may be central. Can make use of the general aspiration of liver puncture, puncture during selective angiography or hepatic arteriography, etc. to help the diagnosis. Confirmed that a large dead space and hematoma debridement should be cut, bleeding and drainage. If the tear is more serious and general ligation, suture hemostasis does not work, consideration should be given after the suture omental packing or partial hepatectomy.
The treatment of penetrating injury of liver: If non-linear damage, can be imported or exported by the catheters Add Road to attract injury or normal saline flush to remove blood clots, foreign bodies and the liver tissue chipped off. If the bleeding has ended, no need to suture the wound in general, in the import and export to nearby drainage placement. If there is a greater injury Road dead space and activities of bleeding, debridement should be cut, bleeding and drainage.
Treatment for injury of hepatic inferior vena cava or hepatic vein stem: general this injury have large amount of bleeding and the risk of air embolism, but not easy to diagnose, and direct suture is extremely difficult to stop bleeding. After the completion of above treatment but still relatively large number of bleeding, should suspect inferior vena cava or hepatic vein injury. Surgery may be the following procedure: fill in fracturing with gauze pads to control the bleeding wound, the extension of the right seventh or eighth intercostal incision, endanger the liver and liver revealed the second door, blocking the blood flow of hepatic ligament and control, superior vena cava gap, the bottom of the flow, in the open repair of ruptured hepatic vein or inferior vena cava dry and restore the blocked blood flow.