目的：探讨纱布填塞压迫在严重外伤性肝破裂治疗中的应用效果。方法回顾性分析应用纱布填塞压迫治疗的18例严重肝挫裂伤患者的临床资料。用纱布填塞压迫，术后经止血药、抗生素和营养支持治疗，于5～7 d 开始逐渐拔除纱布，12～14 d 拔...目的：探讨纱布填塞压迫在严重外伤性肝破裂治疗中的应用效果。方法回顾性分析应用纱布填塞压迫治疗的18例严重肝挫裂伤患者的临床资料。用纱布填塞压迫，术后经止血药、抗生素和营养支持治疗，于5～7 d 开始逐渐拔除纱布，12～14 d 拔完，伤口无出血，逐渐愈合。结果治愈17例，死亡1例，治愈率95％，死亡原因为合并多发伤致多脏器功能衰竭；术后拔出纱布（或绷带）再次出血6例，2例继发出血，药物难以控制，再次剖腹手术止血；术后4例出现膈下积液、感染，并发胆瘘5例、肝脓肿2例、腹腔感染3例、切口感染3例。结论对于严重肝破裂患者纱布填塞压迫止血仍是一种紧急情况下简单有效的处理方法，适合基层医院，既是一种治疗方法，又可填塞压迫暂时止血，为送往上级医院彻底处理赢得时间，可以有效地降低患者病死率，减少并发症。展开更多
This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She d...This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She discovered a mass in her right hypochondrium. Her hepatic ultrasonography showed a round mass (20.3 cm × 17.3 cm × 16.0 cm in size) with fluid echogenicity in the right lobe of her liver, and a hepatic cystic-solid mass (19.7 cm × 18.5 cm × 15.6 cm in size) was identified in an abdominal computerized tomography scan. Several pieces of gauze were extracted, and brown pus from the hepatic mass was suctioned during her exploratory laparotomy. Histology documented gauze remnants with necrotic material inclusions and fibrotic capsules. To our knowledge, this patient's case represents the longest time for which a foreign body has been retained in the liver. In addition, we conducted a comprehensive literature review of foreign bodies retained in the liver. Foreign bodies may be introduced into the liver via penetrating trauma, surgical procedures or the ingestion of foreign bodies (which then migrate from the gut). Thus, they can be classified into the following three categories: penetrating, medical and migrated foreign bodies. The details of the case are thoroughly described.展开更多
文摘目的：探讨纱布填塞压迫在严重外伤性肝破裂治疗中的应用效果。方法回顾性分析应用纱布填塞压迫治疗的18例严重肝挫裂伤患者的临床资料。用纱布填塞压迫，术后经止血药、抗生素和营养支持治疗，于5～7 d 开始逐渐拔除纱布，12～14 d 拔完，伤口无出血，逐渐愈合。结果治愈17例，死亡1例，治愈率95％，死亡原因为合并多发伤致多脏器功能衰竭；术后拔出纱布（或绷带）再次出血6例，2例继发出血，药物难以控制，再次剖腹手术止血；术后4例出现膈下积液、感染，并发胆瘘5例、肝脓肿2例、腹腔感染3例、切口感染3例。结论对于严重肝破裂患者纱布填塞压迫止血仍是一种紧急情况下简单有效的处理方法，适合基层医院，既是一种治疗方法，又可填塞压迫暂时止血，为送往上级医院彻底处理赢得时间，可以有效地降低患者病死率，减少并发症。
基金Supported by Grants from the Technology Program of the Science Technology Department of Zhejiang Province, No.2011C37087the National Natural Science Foundation of China, No. 81000065
文摘This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She discovered a mass in her right hypochondrium. Her hepatic ultrasonography showed a round mass (20.3 cm × 17.3 cm × 16.0 cm in size) with fluid echogenicity in the right lobe of her liver, and a hepatic cystic-solid mass (19.7 cm × 18.5 cm × 15.6 cm in size) was identified in an abdominal computerized tomography scan. Several pieces of gauze were extracted, and brown pus from the hepatic mass was suctioned during her exploratory laparotomy. Histology documented gauze remnants with necrotic material inclusions and fibrotic capsules. To our knowledge, this patient's case represents the longest time for which a foreign body has been retained in the liver. In addition, we conducted a comprehensive literature review of foreign bodies retained in the liver. Foreign bodies may be introduced into the liver via penetrating trauma, surgical procedures or the ingestion of foreign bodies (which then migrate from the gut). Thus, they can be classified into the following three categories: penetrating, medical and migrated foreign bodies. The details of the case are thoroughly described.
