Kodadek Lisa M, Efron David T, Haut Elliott R
Department of Surgery, Vanderbilt University School of Medicine, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed 6107C, 1800 Orleans St., Baltimore, MD, 21287, USA.
World J Surg. 2019 Feb;43(2):486-489. doi: 10.1007/s00268-018-4812-6.
Severe penetrating liver injuries are associated with high rates of morbidity and mortality. The objective of this study was to demonstrate the 15-year experience of a Level 1 US trauma center with use of intrahepatic balloon tamponade for penetrating liver injuries in adult patients.
Operative notes were used to identify cases employing intrahepatic balloon tamponade. Charts were reviewed for patient characteristics, injury characteristics, morbidity, and in-hospital mortality.
Of the 4961 penetrating trauma patients admitted during the study period, 279 (5.6%) had liver injury and underwent exploratory laparotomy. Intrahepatic balloon tamponade was attempted in nine patients (3.2%). Two of the nine patients (22%) were in cardiac arrest at time of balloon placement and died during the index operation; both had retrohepatic IVC injury combined with cardiopulmonary injury. In patients who reached the operating room alive and had spontaneous circulation at the time of balloon placement, utilization of this technique was associated with 100% survival.
Although rarely needed, trauma surgeons must be prepared to use intrahepatic balloon tamponade as one surgical technique to control major hepatic injuries.
严重穿透性肝损伤与高发病率和死亡率相关。本研究的目的是展示美国一家一级创伤中心15年来在成年患者穿透性肝损伤中使用肝内球囊填塞术的经验。
通过手术记录来确定采用肝内球囊填塞术的病例。查阅病历以了解患者特征、损伤特征、发病率和院内死亡率。
在研究期间收治的4961例穿透性创伤患者中，279例（5.6%）发生肝损伤并接受了剖腹探查术。9例患者（3.2%）尝试了肝内球囊填塞术。9例患者中有2例（22%）在放置球囊时心脏骤停，并在首次手术期间死亡；这2例患者均有肝后下腔静脉损伤合并心肺损伤。在存活到达手术室且放置球囊时具有自主循环的患者中，使用该技术的患者生存率为100%。
尽管很少需要，但创伤外科医生必须准备好将肝内球囊填塞术作为控制严重肝损伤的一种手术技术。
