Department of Surgery, The University of Kansas School of Medicine-Wichita, 929 N, Saint Francis Street, Wichita, Kansas 67214, USA.
World J Emerg Surg. 2012 Dec 5;7(1):38. doi: 10.1186/1749-7922-7-38.
The authors present a novel approach to nonresectional therapy in major hepatic trauma utilizing intraabdominal perihepatic vacuum assisted closure (VAC) therapy in the porcine model of Grade V liver injury.
A Grade V injury was created in the right lobe of the liver in a healthy pig. A Pringle maneuver was applied (4.5 minutes total clamp time) and a vacuum assisted closure device was placed over the injured lobe and connected to suction. The device consisted of a perforated plastic bag placed over the liver, followed by a 15 cm by 15cm VAC sponge covered with a nonperforated plastic bag. The abdomen was closed temporarily. Blood loss, cardiopulmonary parameters and bladder pressures were measured over a one-hour period. The device was then removed and the animal was euthanized.
Feasibility of device placement was demonstrated by maintenance of adequate vacuum suction pressures and seal. VAC placement presented no major technical challenges. Successful control of ongoing liver hemorrhage was achieved with the VAC. Total blood loss was 625 ml (20ml/kg). This corresponds to class II hemorrhagic shock in humans and compares favorably to previously reported estimated blood losses with similar grade liver injuries in the swine model. No post-injury cardiopulmonary compromise or elevated abdominal compartment pressures were encountered, while hepatic parenchymal perfusion was maintained.
These data demonstrate the feasibility and utility of a perihepatic negative pressure device for the treatment of hemorrhage from severe liver injury in the porcine model.
作者提出了一种针对严重肝外伤的非切除术治疗新方法，即在猪的 5 级肝损伤模型中利用腹腔内肝周负压封闭引流（VAC）治疗。
在健康猪的右肝叶造成 5 级损伤。应用普雷尔手法（总夹闭时间 4.5 分钟），并将负压封闭引流装置置于受伤的肝叶上并连接抽吸。该装置由一个置于肝上的穿孔塑料袋组成，然后是一个 15cm×15cm 的 VAC 海绵，覆盖一个非穿孔塑料袋。腹部暂时关闭。在一个小时的时间内测量失血量、心肺参数和膀胱压力。然后取出装置并对动物实施安乐死。
通过维持足够的真空抽吸压力和密封，证明了设备放置的可行性。VAC 放置没有带来重大技术挑战。VAC 成功地控制了持续的肝出血。总失血量为 625ml（20ml/kg）。这相当于人类 II 级失血性休克，与之前在猪模型中类似等级肝损伤报告的估计失血量相比具有优势。未出现损伤后心肺功能障碍或升高的腹腔间隔室压力，同时保持肝实质灌注。
这些数据表明，在猪模型中，肝周负压装置治疗严重肝外伤出血具有可行性和实用性。
