UseofTannedCollagenSpongesintheTreatmentofLiverInjuries使用胶原海绵治疗肝损伤**北卡罗来纳州ALTHOUGHthemortalityrateofpenetratingwoundsoftheliverhasprogressivelydeclinedfromareportedincidenceof70percentin1939toaround20percentin1955,themortalityrateofanonpenetratinginjurycausingruptureoftheliverremainsaround75percentandhasnotbeenaffectedbytheadventofantibiotics,transfusionsorothertechnicaladjuvantstoupperabdominalsurgery.虽然穿透伤的肝的死亡率已逐步下降,从1939年70%至1955年20%左右，非穿透性损伤造成肝破裂的死亡率仍约75％,并且不受抗生素、输血或其他技术手段的更新对上腹部手术的影响。Theproblemisoneofextensivemacerationofhepatictissue,secondarytomultipleradiatingfracturescrossinginterlobarlinesandoftenextendingdeepintothehilarregiontoinvolvelargebloodvesselsandbiliaryradicals.问题是一个广泛浸渍的肝组织，继发多个辐射状挫伤与叶间线交错，并经常深入到要涉及大血管和胆道的肝门部区域。Controlofhemorrhageandbileleakageuniversallyistheproblemofthesurgeonandexperiencehasshownthat,whenpossible,resection（切除）oftheinvolvedlobe,oftenunderhypothermic(低温)anesthesia（麻醉）,issuperiortoanyotherknownformoftreatment.出血和胆汁泄漏的控制普遍是外科医生的问题，经验表明，往往在低温麻醉下切除涉及的肝小叶是优于其他任何已知形式的治疗方式。Afterresectionhasbeenperformed,however,orincaseswhereresectionisnotpossiblebecauseoftheextentoftheinjury,inadequatehospitalfacilities,orinsufficienttrainingofthesurgeon,partiallossofGlisson'scapsulemaymakesecondaryoozingofbloodandbileadifficulttechnicalproblem.然而，在执行切除之后，或在某些情况下由于损伤的程度、医院的设施不足或外科医生的培训不足，肝切除无法进行，或Glisson囊的部分损伤都可能引起二次渗血和胆汁渗漏，这是一个很难的技术问题。Manymethodstocareforthissuchasmassligatures,compressionclamps,specialneedles,platesofIvalonormetal,orivory,applicationofvarioushemostaticagents(oxygel,gelfoam,fibrinogen,hemastolplugs)andrapidlypolymerizingadhesiveshavebeenadvocated.现在有很多方法，如大量结扎线、压缩钳、特殊针头、聚乙烯或金属板或ivory，各种止血剂(oxygel、明胶...
