Svoboda J A, Peter E T, Dang C V, Parks S N, Ellyson J H
Am J Surg. 1982 Dec;144(6):717-21. doi: 10.1016/0002-9610(82)90557-8.
Most liver injuries lend themselves to satisfactory hemostasis and drainage, with or without resectional debridement. A small number of injuries will necessitate massive blood transfusion with clinically significant coagulopathy developing in about half of these patients despite prophylactic infusion of fresh frozen plasma and platelet concentrates. In our experience, after major, discrete arterial and venous vessels are individually ligated, the diffuse ooze from the raw surfaces can be effectively controlled by temporary packing of the liver. Packing provides time for coagulopathy and hypothermia to be corrected and for urgent diagnostic maneuvers to be completed safely. Packs should be removed early (within 24 to 48 hours postoperatively), and surgery performed as indicated by the injury. No intraabdominal abscesses have been encountered among our 12 patients who underwent temporary packing of their liver injuries.
大多数肝损伤，无论是否进行切除清创术，都能实现满意的止血和引流。少数损伤需要大量输血，尽管预防性输注了新鲜冰冻血浆和血小板浓缩液，但约一半的此类患者仍会出现具有临床意义的凝血病。根据我们的经验，在分别结扎主要的、离散的动脉和静脉血管后，通过对肝脏进行临时填塞，可以有效控制创面的弥漫性渗血。填塞为纠正凝血病和体温过低以及安全完成紧急诊断操作提供了时间。填塞物应尽早取出（术后24至48小时内），并根据损伤情况进行手术。在我们12例接受肝损伤临时填塞的患者中，未出现腹腔内脓肿。
