Encke A, Holzer K
Department of Surgery, J.W. Goethe University, Frankfurt/Main.
Ann Ital Chir. 1992 Nov-Dec;63(6):719-24.
From our own experience with 104 patients with liver trauma treated by laparotomy we confirmed the present trends in treating blunt liver trauma, i.e. conservative therapy of minor lesions under closed observation with imaging procedures (US and CT-scan); minor local measures in superficial liver injuries when laparotomy is performed for other reasons; generous use of the Pringle maneuver in primary hemostasis; temporary or final treatment by perihepatic packing in all parenchymal fractures with predominant venous bleeding; direct suture or ligation of arterial bleeding; liver resection only for the debridement of destroyed tissue. With primary packing the patient can be transferred to an experienced center. The overall mortality is more dependent on combined lesions from polytrauma. The early and efficient hemostasis of liver trauma may, however, stabilize the border-line patient and give him a better chance. This is underlined by the experience, that isolated liver injuries have a much better prognosis except central lesions of the retrohepatic vena cava and large central hepatic veins.
根据我们对104例接受剖腹手术治疗的肝外伤患者的经验，我们证实了目前钝性肝外伤的治疗趋势，即对轻度损伤在影像学检查（超声和CT扫描）密切观察下进行保守治疗；因其他原因行剖腹手术时对浅表肝损伤采取局部小手术；在原发性止血中广泛应用Pringle手法；对所有以静脉出血为主的实质内骨折采用肝周填塞进行临时或最终治疗；对动脉出血进行直接缝合或结扎；仅对毁损组织进行清创时行肝切除术。采用初次填塞可将患者转运至经验丰富的中心。总体死亡率更多地取决于多发伤合并的损伤。然而，肝外伤的早期有效止血可能使临界患者病情稳定，使其有更好的生存机会。孤立性肝损伤（除肝后腔静脉和肝中央大静脉的中央损伤外）预后要好得多，这一经验也证实了这一点。
