Hollands M J, Little J M
Department of Surgery Westmead Hospital, New South Wales, Australia.
Aust N Z J Surg. 1989 Jan;59(1):21-4. doi: 10.1111/j.1445-2197.1989.tb01459.x.
Perihepatic packing was used in 25 of 197 (12.7%) patients presenting with liver trauma to Westmead Hospital over an 8 year period. Packing was used either to provide temporary haemostasis prior to transfer or as part of a definitive treatment plan at this hospital. Thirteen patients were packed prior to transfer. Only two were unstable on arrival, one of whom died. They were compared with 18 'comparison' patients with liver injuries of similar severity. In this group 10 were unstable on arrival (P = 0.027), nine of whom died (P = 0.015). Packing was used as part of a definitive treatment plan at Westmead on 17 occasions. Four patients were coagulopathic and five had also been packed prior to arrival. Eight of this group died. Packing is a convenient and safe way of controlling major hepatic haemorrhage prior to transfer to a tertiary referral centre. It may also be part of a definitive treatment plan to control hepatic bleeding especially as many patients arrive with a coagulopathy or develop a coagulopathy during the course of surgery to control bleeding. Packing will control haemorrhage until the coagulopathy has been corrected.
在8年的时间里，西梅德医院收治的197例肝外伤患者中，有25例（12.7%）采用了肝周填塞法。填塞法要么是在转运前用于提供临时止血，要么是作为本院确定性治疗方案的一部分。13例患者在转运前进行了填塞。到达时仅有2例情况不稳定，其中1例死亡。将他们与18例伤情严重程度相似的“对照”肝损伤患者进行比较。在这组对照患者中，10例到达时情况不稳定（P = 0.027），其中9例死亡（P = 0.015）。在西梅德医院，填塞法有17次被用作确定性治疗方案的一部分。4例患者存在凝血功能障碍，5例在到达之前也已进行了填塞。这组中有8例死亡。填塞法是在转运至三级转诊中心之前控制严重肝出血的一种简便且安全的方法。它也可能是控制肝出血的确定性治疗方案的一部分，特别是因为许多患者在到达时就存在凝血功能障碍，或者在控制出血的手术过程中出现凝血功能障碍。填塞法将控制出血，直到凝血功能障碍得到纠正。
