Thapar Pinky M, Ghawat Ravindra M, Dalvi Abhay N, Rokade Muktachand L, Philip Roji M, Warawdekar Gireesh M, Bapat Mukta R
Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India ; D-6, Vishram Dham, Veena Nagar Phase II, Mulund (West), Mumbai, 80 India.
Department of Minimal Invasive surgery, Critical Care, Radiology and Endoscopy, Jupiter Hospital, Thane Maharashtra, India.
Indian J Surg. 2013 Jun;75(Suppl 1):449-52. doi: 10.1007/s12262-012-0781-4. Epub 2012 Dec 16.
Management of massive liver trauma (grades IV-VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1 year follow-up.
巨大肝外伤（IV - VI级）的处理与高发病率和死亡率相关。它会给治疗医生带来严峻挑战，需要多模式干预。为取得成功的治疗结果，干预时机至关重要。我们报告一例V级肝损伤病例，在入院至第24天出院期间，通过血管栓塞、腹腔镜灌洗和内镜支架置入术成功治疗。复苏后入院时即行血管栓塞，因为CT扫描显示动脉期有活动性造影剂外渗。由于腹部炎症反应对药物治疗无反应，于第5天行腹腔镜灌洗和引流。腹腔镜检查时发现腹腔积液中有胆汁成分，术后表现为局限性胆瘘；因此在第7天行胆管内镜支架置入术。患者通过及时的微创方法恢复良好，1年随访时情况良好。
