Bakker F C, Wille F, Patka P, Haarman H J
Department of Surgery, Free University Hospital, Amsterdam, the Netherlands.
J Trauma. 1995 Jun;38(6):891-4. doi: 10.1097/00005373-199506000-00011.
Uncontrollable bleeding remains a life-threatening problem in severe liver injury. The application of an absorbable mesh has been reported in a small number of patients. To evaluate an absorbable mesh wrap in standardized conditions, we performed an experimental study in 14 female pigs. A standard liver laceration imitating a blunt injury grade IV (Liver Injury Scale of the American Association for the Surgery of Trauma) was made in all animals. Heparin was administered to mimic coagulopathy. After randomization, seven animals received a polyglycolic acid (Vicryl) mesh wrap to control bleeding. Seven animals served as controls. Six of seven animals with a mesh wrap survived. Six of seven animals in the control group died (p = 0.02, Fisher's exact test). Intrahepatic pressures in the treated group varied from 3 to 55 mm Hg. Liver function tests in surviving animals were temporarily elevated. Necropsy at 2 weeks demonstrated adhesions to the wrapped lobe, but no hematoma, free bile, or abscess. Histologic examination showed a foreign-body reaction to the mesh and necrotic parts in the liver. It is concluded that an absorbable mesh wrap can effectively control bleeding from severe liver injury and improve survival in an animal model, although it may cause some damage to liver tissue.
在严重肝损伤中，难以控制的出血仍然是一个危及生命的问题。少数患者中已报道了可吸收网片的应用。为了在标准化条件下评估可吸收网片包裹术，我们对14只雌性猪进行了一项实验研究。在所有动物身上制造了模仿钝性损伤IV级（美国创伤外科协会肝脏损伤分级）的标准肝裂伤。给予肝素以模拟凝血病。随机分组后，7只动物接受聚乙醇酸（薇乔）网片包裹以控制出血。7只动物作为对照。接受网片包裹的7只动物中有6只存活。对照组的7只动物中有6只死亡（p = 0.02，Fisher精确检验）。治疗组的肝内压力在3至55毫米汞柱之间变化。存活动物的肝功能测试暂时升高。2周时的尸检显示包裹叶有粘连，但无血肿、游离胆汁或脓肿。组织学检查显示对网片和肝脏坏死部分有异物反应。结论是，可吸收网片包裹术可有效控制严重肝损伤的出血并提高动物模型的存活率，尽管它可能对肝组织造成一些损害。
