Chamseddine Ghassan, Khalifeh Mohamed, Khoury Ghattas, Hoballah Jamal, El Nounou Ghina, Nassar Hussein, Faraj Walid
Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Int J Surg Case Rep. 2016;25:37-9. doi: 10.1016/j.ijscr.2016.05.031. Epub 2016 Jun 5.
Major liver trauma is a potentially fatal injury. Management of liver injuries has considerably changed over the past decades with a trend towards a multidisciplinary approach. Most liver injuries can be managed conservatively; however, some cases need operative management.
We present a case of a 73year old female who underwent laparoscopic cholecystectomy that was complicated by a life-threatening liver fracture and was successfully managed by staged laparotomies and liver mesh-wrapping.
Mesh wrapping is an effective approach for achieving hemostasis by a temponading effect. An alternative to liver packing would be the resection of the affected segmented, however this should be assessed based on the extent of the injury as well as on the hemodynamic stability of the patient who, in majority, are hemodynamically compromised. The advantage however of liver wrapping is that there is no need for reoperation to remove the mesh, the hazard of re-bleeding is diminished because the mesh is left in place, and the incidence of septic complications is low. In this case, the mesh was sutured to the diaphragmatic crus as well as to the falciform ligament to secure the mesh on two anchoring points.
Using an absorbable mesh on a traumatized and fragmented liver appears to be a safe and effective approach to high grade liver injury. The judicious use of cauterization, beaming or suturing to the liver bed to control oozing or bleeding should be advocated in order to avoid this highly morbid complication.
严重肝外伤是一种潜在的致命性损伤。在过去几十年中，肝损伤的治疗方法发生了很大变化，呈现出多学科治疗的趋势。大多数肝损伤可以保守治疗；然而，有些病例需要手术治疗。
我们报告一例73岁女性患者，她接受了腹腔镜胆囊切除术后并发危及生命的肝破裂，通过分期剖腹手术和肝网包裹成功治疗。
网片包裹是一种通过填塞作用实现止血的有效方法。肝部分切除术是肝填塞的一种替代方法，但应根据损伤程度以及患者的血流动力学稳定性进行评估，大多数患者存在血流动力学不稳定的情况。然而，肝包裹的优点是无需再次手术取出网片，由于网片留在原位，再出血的风险降低，且感染并发症的发生率较低。在本病例中，网片缝合至膈肌脚以及镰状韧带，以在两个固定点固定网片。
在创伤性和破碎性肝脏上使用可吸收网片似乎是治疗高级别肝损伤的一种安全有效的方法。应提倡明智地使用烧灼、束光或缝合至肝床以控制渗血或出血，以避免这种高发病率的并发症。
