David Richardson J, Franklin G A, Lukan J K, Carrillo E H, Spain D A, Miller F B, Wilson M A, Polk H C, Flint L M
Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
Ann Surg. 2000 Sep;232(3):324-30. doi: 10.1097/00000658-200009000-00004.
To define the changes in demographics of liver injury during the past 25 years and to document the impact of treatment changes on death rates.
No study has presented a long-term review of a large series of hepatic injuries, documenting the effect of treatment changes on outcome. A 25-year review from a concurrently collected database of liver injuries documented changes in treatment and outcome.
A database of hepatic injuries from 1975 to 1999 was studied for changes in demographics, treatment patterns, and outcome. Factors potentially responsible for outcome differences were examined.
A total of 1,842 liver injuries were treated. Blunt injuries have dramatically increased; the proportion of major injuries is approximately 16% annually. Nonsurgical therapy is now used in more than 80% of blunt injuries. The death rates from both blunt and penetrating trauma have improved significantly through each successive decade of the study. The improved death rates are due to decreased death from hemorrhage. Factors responsible include fewer major venous injuries requiring surgery, improved outcome with vein injuries, better results with packing, and effective arterial hemorrhage control with arteriographic embolization.
The treatment and outcome of liver injuries have changed dramatically in 25 years. Multiple modes of therapy are available for hemorrhage control, which has improved outcome.
明确过去25年肝损伤人口统计学特征的变化，并记录治疗变化对死亡率的影响。
尚无研究对大量肝损伤病例进行长期回顾，记录治疗变化对预后的影响。一项对同时收集的肝损伤数据库进行的25年回顾记录了治疗及预后的变化。
研究1975年至1999年肝损伤数据库中人口统计学特征、治疗模式及预后的变化。对可能导致预后差异的因素进行了检查。
共治疗1842例肝损伤患者。钝性损伤显著增加；每年重伤比例约为16%。目前超过80%的钝性损伤采用非手术治疗。在研究的每一个连续十年中，钝性和穿透性创伤的死亡率均显著改善。死亡率的改善归因于出血导致的死亡减少。相关因素包括需要手术的主要静脉损伤减少、静脉损伤的预后改善、填塞效果更好以及动脉造影栓塞有效控制动脉出血。
25年来肝损伤的治疗及预后发生了巨大变化。有多种控制出血的治疗方式，改善了预后。
