Chấn thương quản lý Hầu hết các phẫu thuật gan rất đơn giản và có thể được điều trị tương đối dễ dàng. Tổn thương phức tạp cần phải được chẩn đoán sớm và có thể cần phải phẫu thuật lớn của một bác sĩ phẫu thuật gan mật có kinh nghiệm. | Liver and pancreatic trauma Surgical management Most liver injuries are simple and can be treated relatively easily. Complex lesions need to be diagnosed early and may require major surgery by an experienced hepatobiliary surgeon. The priorities of surgery are to stop haemorrhage remove dead or devitalised liver tissue and ligate or repair damaged blood vessels and bile ducts. Operative approach Patients should be prepared from the sternal notch to the pubis so that the incision can be extended into the chest if more proximal control of the vena cava or aorta is needed. A midline incision is used and the first step is to remove blood and clots and control active bleeding from liver lacerations by packing. Care should be taken to avoid sustained periods of hypotension and it is important to restore the patient s circulating blood volume during surgery. Any perforations in the bowel should be rapidly sutured to minimise contamination. Most liver injuries have stopped bleeding spontaneously by the time of surgery. These wounds do not require suturing but should be drained to prevent bile collections. Liver bleeding can usually be stopped by compressing the liver with abdominal packs while experienced surgical and anaesthetic help is summoned. If visibility is obscured by continued bleeding the hepatic artery and portal vein should be temporarily clamped with a vascular clamp to allow accurate identification of the site of bleeding. If bleeding cannot be stopped the area should be packed absorbable gauze mesh can be wrapped around an injured lobe and sutured to maintain pressure and tamponade bleeding. The abdomen is then closed without drainage and the packing removed under general anaesthesia two to three days later. Packing is also used if a coagulopathy develops or to allow the patient to be transferred to a tertiary referral unit for definitive management. Patients with blunt injuries associated with substantial amounts of parenchymal destruction may require .
