Venzi G, Martinoli S
Service de chirurgie, Ospedale Civico, Lugano.
Helv Chir Acta. 1994 Jul;60(5):813-6.
The management of severe hepatic trauma may represent a challenge in the presence of haemodynamic instability, coagulopathy, hypothermia or metabolic failure. Moreover, the choice of treatment should consider the prevention of complications. The omentum has many advantages including hemostasis, infection preventing, viability and adaptability to reconstruction as a space filler. We report the case of a 19 year-old patient who sustained a gunshot wound, involving the right elbow and forearm and the abdomen with burst of right kidney and a penetrating centro-hepatic injury (stage IV). Surgical treatment was successfully performed in two times, by gauze packing for temporary control of haemostasis and after 24 hours by omental packing to fill the dead space of hepatic lesion. The viable omentum was placed through the hepatic hole and fixed posteriorly to the skin. The postoperative period was uneventful, excluding the development of a biliary fistula which resolved after external drainage. We conclude that omental packing is a valid solution when dealing with penetrating liver injury.
在存在血流动力学不稳定、凝血病、体温过低或代谢衰竭的情况下，严重肝外伤的处理可能是一项挑战。此外，治疗方法的选择应考虑预防并发症。大网膜具有许多优点，包括止血、预防感染、存活能力以及作为空间填充物进行重建的适应性。我们报告了一例19岁患者的病例，该患者遭受枪伤，累及右肘和前臂以及腹部，右肾破裂且有肝中央穿透伤（IV期）。分两次成功进行了手术治疗，第一次用纱布填塞以临时控制出血，24小时后用大网膜填塞以填充肝脏损伤的死腔。将有活力的大网膜通过肝创口置入并固定于后方皮肤。术后过程顺利，除了出现胆瘘，经外引流后胆瘘得以解决。我们得出结论，在处理穿透性肝损伤时，大网膜填塞是一种有效的解决方法。
