Seligman J Y, Egan M
Department of General Surgery, Naval Medical Center, San Diego, California 92134-5000, USA.
Am Surg. 1997 Nov;63(11):1022-3.
Penetrating hepatic injury remains a therapeutic challenge for the surgeon. Surgical technique for the management of penetrating hepatic trauma includes balloon tamponade, which is most useful for central gunshot wounds that pass through both lobes. Our patient had two entrance wounds and no exit wounds. However, a bullet was palpable in the subcutaneous tissue just beneath the right shoulder in the supraclavicular region. A Penrose drain and red rubber catheter balloon device were placed in the abdominal cavity. The balloon device was inflated for 48 hours, after which the Penrose drain was allowed to slowly deflate and was removed. The abdomen was re-explored, found to be negative, and then closed. The patient's postoperative course was uneventful, and he was discharged on postoperative day 14. The use of balloon tamponade is an option that should be kept in the surgeon's armamentarium for use in selected patients with hepatic trauma.
穿透性肝损伤对外科医生来说仍然是一个治疗挑战。处理穿透性肝外伤的手术技术包括球囊填塞，这对穿过两叶的中央枪伤最为有用。我们的患者有两个入口伤口，没有出口伤口。然而，在锁骨上区域右肩下方的皮下组织中可触及一颗子弹。在腹腔内放置了一根橡皮引流管和一个红色橡胶导管球囊装置。球囊装置充气48小时，之后让橡皮引流管缓慢放气并拔除。再次探查腹腔，结果为阴性，然后关闭腹腔。患者术后恢复顺利，术后第14天出院。球囊填塞的应用是一种选择，应保留在外科医生的手术器械库中，用于选定的肝外伤患者。
