Study on the application of minimally invasive gauze pad in the secondary operation of liver rupture in plateau area

doi:10.3877/cma.j.issn.1674-3946.2025.02.021.

Abstract

Abstract:

Objective

To analyze the effect of minimally invasive laparoscopy and traditional small incision in the second stage of liver rupture in high altitude area.

Methods

A total of 60 patients with traumatic liver rupture who received simple perihepatic gauze packing for hemostasis from January 2017 to December 2022 were selected and divided into two groups by random number table method, with 30 patients in each group.The control group underwent two stage traditional small incision operation and the observation group underwent two stage laparoscopic operation.Statistical software SPSS 23.0 was used to analyze the data.The counting data were presented as［ cases (%)］, and the comparison between groups was performed by χ² test.Rank Sum test was used to compare rank count data.The measurement data conforming to the normal distribution were represented by (± s ), and the independent sample t test was used for comparison between groups.P＜0.05 indicated that the difference was statistically significant.

Results

The operation time of observation group was longer than that of control group, and the amount of blood loss, abdominal incision size, postoperative hospitalization time,hospitalization cost and postoperative 1d and 3d VAS scores were all better than those of control group, with statistical significance (P＜0.05).Compared with preoperative, postoperative WBC, CRP and IL-6 levels in 2 groups were increased, and control group was significantly higher than observation group, the difference was statistically significant (P＜0.05).The total incidence of postoperative complications in the observation group was 10.0%, significantly lower than that in the control group (33.3%), and the difference was statistically significant (P＜0.05).

Conclusion

Compared with traditional small-incision open surgery, laparoscopic gauze pad extraction in the second stage for patients with liver rupture in plateau areas can prolong the operation time, but it has the advantages of less bleeding, small incision and light pain.At the same time, it can reduce postoperative inflammation, reduce the incidence of complications, and is more conducive to postoperative recovery of patients.It has high economic benefits and application value, and is worthy of clinical promotion.

Key words: Liver Rupture, Laparoscopes, Laparotomy, Perihepatic Pad Removal

Puliang Qi, Kaihua Sun, Junbang Ren, Lina Ma, Caixia Li, Qingshan Tian. Study on the application of minimally invasive gauze pad in the secondary operation of liver rupture in plateau area[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 196-199.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.02.021.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I02/196

Figures/Tables 4

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
观察组	30	19/11	38.6±8.4	22.4±1.5
对照组	30	23/7	40.8±7.9	22.1±1.7
Z/t值		1.270	1.045	0.725
P值		0.260	0.300	0.472
组别	例数	Chid-Pugh分级（例）	AAST分级（例）	一、二期手术时间间隔（d， $\overset{ˉ}{x}$ ±s）
组别	例数	A/B级	Ⅲ/Ⅳ/Ⅴ级	一、二期手术时间间隔（d， $\overset{ˉ}{x}$ ±s）
观察组	30	14/16	19/7/4	7.9±0.6
对照组	30	18/12	15/10/5	8.1±0.7
Z/t值		1.071	0.377	1.188
P值		0.301	0.706	0.240

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
观察组	30	19/11	38.6±8.4	22.4±1.5
对照组	30	23/7	40.8±7.9	22.1±1.7
Z/t值		1.270	1.045	0.725
P值		0.260	0.300	0.472
组别	例数	Chid-Pugh分级（例）	AAST分级（例）	一、二期手术时间间隔（d， $\overset{ˉ}{x}$ ±s）
组别	例数	A/B级	Ⅲ/Ⅳ/Ⅴ级	一、二期手术时间间隔（d， $\overset{ˉ}{x}$ ±s）
观察组	30	14/16	19/7/4	7.9±0.6
对照组	30	18/12	15/10/5	8.1±0.7
Z/t值		1.071	0.377	1.188
P值		0.301	0.706	0.240

组别	例数	手术时间（min）	术中出血量（ml）	腹壁切口大小（cm）
观察组	30	50.6±5.4	57.2±6.8	2.3±0.4
对照组	30	39.4±3.7	168.8±12.4	9.1±1.5
t值		9.371	54.841	23.992
P值		0.000	0.000	0.000
组别	例数	术后住院时间（d）	住院费用（万元）	VAS评分（分）
组别	例数	术后住院时间（d）	住院费用（万元）	术后1d	术后3d
观察组	30	15.2±0.8	3.7±0.6	3.6±1.2	1.5±0.6
对照组	30	26.5±0.7	6.1±0.4	4.3±1.1	2.4±1.2
t值		58.224	18.229	2.355	3.674
P值		0.000	0.000	0.022	0.001

组别	例数	时间	WBC（×10⁹/L）	CRP（mg/L）	IL-6（μg/L）
观察组	30	术前	8.6±2.4	14.5±4.2	34.9±4.1
观察组	30	术后	13.3±3.8^ab	17.8±5.6^ab	50.7±6.3^ab
对照组	30	术前	8.1±2.3	14.6±3.7	34.2±4.3
对照组	30	术后	16.2±4.7^a	21.4±6.7^a	56.4±5.9^a

组别	例数	肝脏创面出血	切口感染	腹腔残余感染	膈下积液	胆瘘	总并发症
观察组	30	1(3.3)	1(3.3)	0(0.0)	0(0.0)	1(3.3)	3(10.0)
对照组	30	5(16.7)	0(0.0)	4(13.3)	1(3.3)	0(0.0)	10(33.3)
χ ²值		-	-	-	-	-	4.812
P值		-	-	-	-	-	0.028

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