| 【Objective】1. To discuss the feasibility of use the laparoscope combined with percutaneousradiofrequency ablation to control the hemorrhage of blunt hepatic trauma under thefield conditions.which way is expected to be a safe and an effective way to treatmentthe blunt hepatic trauma. and it is easy to promote in clinical and on thewartime.basing on this technique can diagnosis early and assess the injurycomprehensively and accurately, it will help us to avoid unnecessary exploratorylaparotomy and organ resection operations as far as possible. Besides,It will make theminimal, effective and individual therapy into use.2.To analysis the indications,efficacy and safety of this technology used in theliver trauma.3.to make the current new technology and ideas of hepatobiliary surgery apply tothe treatment of the blunt hepatic trauma on the wartime or non-wartime.【Methods】To divide the twenty pigs into two groups randomly.Group A is Searched bylaparoscopy to make further judgement and assessment after30-60minutes of theinjury.and curing the bleeding site through the percutaneous radiofrequency ablationcombine with B ultrasound under the direct vision of laparoscopy. According to levelsof injuries, The animals which treat failure or combine with other organ damagechoose open surgery including liver resection, splenectomy,etc. while Group Bchoose non-surgical treatment,after B-ultrasound to determine the level of liverinjury,include fluid resuscitation, maintain hemodynamic stability, etc. All animals arecarried the stage colletcting blood count, bio-chemical markers, imaging review,etc.as the severe animals with hemodynamic instability and image point to bleeding sustained choose exploratory laparotomy to stop bleeding.and autopsy immediatelywhen the animals died in the course of treatment. Then, Kill the animals On thetwenty-eighth day to autopsy include cutting the full liver,explorating abdominal andchest cavity,recording the occurrence of complications,and so on. the specimens willbe embed inparaffin after dehydration treatment, then routine HE staining,lightmicrcoscopy analysis,and acquisition histological.the specimens will be embedded inparaffin after dehydration treatment, then routine HE staining,light microscopyanalysis,and acquisition histological.【Results】1. stop bleeding time and blood loss.Laparoscopy and radiofrequency ablation in the treatment group and thenon-surgical group in time to stop bleeding, the blood loss in addition to I stage livertrauma have significant differences (P <0.05).2. Glucose, insulin, glucagonComparing with the two groups of animals’ pre-injury blood glucose, INS,GLU,There was no significant difference (P>0.05). Immediate postoperative,afterthe first day, second day after surgery, the two groups of animals blood glucosecompared with the pre-injury has significantly increased (P <0.05). Two days aftersurgery, the surgery group’s blood glucose is higher than the non-surgical group, thedifference was statistically significant (P <0.05). Four days after surgery, bloodglucose of group A returned to the pre-injury level (P>0.05), after10days, bloodglucose of,the non-surgical group returned to normal levels, and the difference wasstatistically significant (P <0.05). The two groups of animals’ insulin decreased in theimmediate postoperative and the difference was statistically significant than injury(P<0.05).1and2days after Postoperative the insulin in both groups was significantlyhigher than before the injury (P <0.05). Four days after surgery, the surgical group’sinsulin decline was no significant difference compared with the injury before(P>0.05),while the non-surgery group were still significantly higher than the pre-injurylevel,compared with the pre-injury and surgery group,the differences were statisticssignificance (P <0.05). insulin in the non-surgical group after7days recoverypre-injury level (P>0.05). Two groups of animals’ postoperative glucagon showed anupward trend, after one day up to a maximum value. compared with pre-injury, thedifference of the two groups of animals’ glucagon in immediate postoperative, postoperative1day, postoperative2day was statistically significant (P <0.05).Fourdays after surgery, the surgery group returned to pre-injury levels. the non-surgicalgroup’s glucagon gradually returned to pre-injury levels in the first seven days (P>0.05),but,There was no differences between groups (P>0.05).3. ALT、AST、Tbil、DbilALT, AST compare two groups of animals before surgery were not significantlydifferent (P>0.05). animals ALT of Immediately, the first day,second day,fourth dayafter surgery was significantly higher, compared with the pre-injury,the differencehas statistically significant (P <0.05). Surgery group reached the highest value in thefirst day after the surgery,the non-surgical group reached the highest value in thefourth day after the surgery,the non-surgical group ALT was significantly higher thanthe surgery group in the fourth day (P <0.05). on the7th day, all of the ALT close topre-injury levels (P>0.05). Immediately after surgery to the fourth day after surgery,the two groups AST were significantly increased, compared with the pre-injury,thedifference was statistically significant (P <0.05). both groups reached the highestvalue at the first day postoperatively. Surgery group AST decline to the pre-injurylevel at seventh day after surgery (P>0.05), and the non-surgical group ASTdeclined, but lower than the pre-injury and surgical group, there are still significantdifference (P <0.05). Tbil and Dbil began to rise slowly after the injury,and reach apeak in the second day.while only the Dbil difference was statistically significant atthe first and second day after surgery compare with the pre-injury in group B (P<0.05),and decline to normal at the fourth day. The surgery group’s Tbil and Dbilcompared with1,2,4days after surgery than pre-injury, the difference was significant(P <0.05),at the seventh day return to nomal levels. Between the two groups were notstatistically significant (P>0.05).【Conclusion】1. Compared with conservative treatment, The RF treatment has the advantage offaster stop bleeding, less blood loss,low complication rate. Laparoscopy combinewith radiofrequency ablation curing hemostasis techniques used in the treatmentof liver trauma is feasible, and it is worth promoting. 2. Laparoscopy combine with radiofrequency ablation curing hemostasis techniquesused in the treatment of liver trauma has many feature include in less trauma,quicker recovery, lighter stress response, lower effect on liver function.3. Laparoscopy combine with radiofrequency ablation has the following technicaladvantages:(1) It is helpful to the early injuries judgment and prevent omission ofmultiple organ injury diagnosis.(2) under direct vision by laparoscopy,RF needlewill more accurate positioning, simpler, lower technical difficulty and morereliable, specially, apply to wartime requirements. |
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