本文關(guān)鍵詞： 肝外傷 動物模型 失血量 止血 規(guī)則性肝切除術(shù) AAST分級　出處：《中國人民解放軍軍醫(yī)進修學院》2007年博士論文　論文類型：學位論文

【摘要】： 背景長期以來，嚴重肝外傷的救治較少從動物實驗中獲益。這與缺乏規(guī)范、良好的(大型)動物模型有關(guān)。已有的體內(nèi)鉗夾法(“Crush-clamping”)及“體外致傷”法肝外傷模型或存?zhèn)檩^輕、為非鈍性傷，或存死亡率高、副損傷重、可重復性差等缺點。因此，重建“新型”嚴重肝外傷動物模型具有重要意義。 嚴重肝外傷的救治仍是嚴峻挑戰(zhàn)。利用自行開發(fā)的可吸收“腹部實質(zhì)器官包扎繃帶”，對適選病例實施損傷肝葉的包扎治療可能是一種極有前景的策略。它不但在理論上優(yōu)于需二次手術(shù)、具較多并發(fā)癥的“紗布填塞”以及死亡率較高的“規(guī)則性肝切除”，而且克服了已有“可吸收網(wǎng)套”的諸多不足(如：形態(tài)匹配欠佳、費工耗時等)�；谛⌒拓i肝葉解剖特點及前期所建動物模型傷情，本研究將首先驗證——與“規(guī)則性肝切除”相較，“腹部實質(zhì)器官包扎繃帶”所具有的理論優(yōu)勢。 目的建立新型嚴重肝外傷(大型)動物模型，并利用其研究“腹部實質(zhì)器官包扎繃帶”治療和“規(guī)則性肝切除”手段孰優(yōu)孰劣。 方法制作“MT-1型(遠距離點火)爆炸致傷裝置”，將爆炸物直接置于擬致傷肝葉表面，在對鄰近器官施以隔離保護措施之后，遙控引爆。監(jiān)測傷后MAP變化及測量肝臟毀損面積S(cm~2)、失血量等指標，用以衡量動物模型的“標準化”程度。其后，應用該法致小型豬Ⅳ級肝外傷(n=8)，隨機分入“腹部實質(zhì)器官包扎繃帶”組(Group B，Bandage)及“規(guī)則性肝切除”組(Group R，Resection)，，選取手術(shù)止血時間(min)、失血量(ml)、術(shù)后肝功能恢復(TB、ALT、AST)等指標對比其優(yōu)劣。 結(jié)果1、代表小型豬傷后早期(2～7min)MAP變化趨勢的回歸系數(shù)介于-3.94與-9.91之間；肝臟毀損面積為12.19±2.28(cm~2)，95％可信區(qū)間為[10.66，13.71](cm~2)。2、“包扎”組手術(shù)失血量小于“切除”組(86.3±25.0 vs.136.3±29.3，P=0.0407)；手術(shù)止血時間未顯示差異(9.00±3.16 vs.10.88±2.39，P=0.3809)；術(shù)后即刻“包扎”組AST高于“切除”組(308.7±92.25vs.162.7±39.50，P=0.0270)，術(shù)后1天“包扎”組AST、ALT均高于“切除”組(400.6±107.26vs.181.7±75.50，P=0.0157、119.3±32.01vs.67.8±16.55，P=0.0289)，術(shù)后TB無差異。 結(jié)論成功建立了符合AASTⅣ級傷情、具有良好可重復性、并在一定程度上具有“鈍性傷”特點的小型豬嚴重肝外傷模型。“腹部實質(zhì)器官包扎繃帶”應用于廣泛星芒狀肝臟損傷暨肝組織無缺血、失活表現(xiàn)時，與傳統(tǒng)“規(guī)則性肝切除”手段相比具有一定的優(yōu)勢，主要表現(xiàn)為手術(shù)失血量減少。
[Abstract]:Background for a long time, the treatment of severe liver trauma has rarely benefited from animal experiments. Good (large) animal models are related. The existing in vivo clamp method ("Crush-clamping") and "in vitro injury" method liver injury model or the existence of light injury, is non-blunt injury. Therefore, it is of great significance to reconstruct the "new" animal model of severe liver injury. The treatment of severe liver trauma is still a serious challenge, using self-developed absorbable "abdominal parenchymal organ bandage". Bandaging of injured liver lobe may be a promising strategy for suitable cases. It is not only better than the need for secondary surgery in theory. The "gauze packing" with more complications and the "regular hepatectomy" with high mortality have overcome many shortcomings of the existing "absorbable mesh" (such as poor morphological matching). Based on the anatomical characteristics of the liver lobe of the small pig and the injury situation of the animal model established in the early stage, this study will first verify the comparison between "regular hepatectomy" and "regular hepatectomy". The theoretical advantage of "abdominal solid organ bandage". Objective to establish a new type of animal model of severe liver trauma and to study the advantages and disadvantages of "abdominal parenchymal organ bandage" and "regular hepatectomy". Methods the "MT-1" explosive injury device was made. The explosive was placed directly on the surface of the liver lobe, and the adjacent organs were protected by isolation. Remote detonation. Monitoring the changes of MAP after injury and measuring the liver damage area (Sch), blood loss and other indicators to measure the "standardized" degree of animal models. The method was used to induce liver trauma of grade 鈪

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