Durham R M, Buckley J, Keegan M, Fravell S, Shapiro M J, Mazuski J
Department of Surgery, St. Louis University Hospital, Missouri 63110-0250.
Am J Surg. 1992 Nov;164(5):477-81. doi: 10.1016/s0002-9610(05)81184-5.
Sixty-three consecutive patients with blunt hepatic trauma were examined. Twenty-four patients underwent immediate operation, and 39 patients were evaluated by computed tomography (CT), of whom 17 underwent operation. Ten patients had no hepatic abnormalities on CT and had operations for associated injuries. Liver injuries were noted in the remaining seven patients, but CT underestimated the injury in four patients. A large hemoperitoneum was present in all seven patients by CT, and the average transfusion was 10 U during initial resuscitation. Twenty-two patients with grade I to III injuries and a small to moderate hemoperitoneum were managed nonoperatively. Six of these patients had transfusions during resuscitation. Only one patient received more than 2 U. There were no deaths and no major complications related to the liver injury. Most patients had repeat CT at 1 week, which demonstrated stable or improving injuries. CT may underestimate the degree of liver injury. Nonoperative management is appropriate in stable patients with grade I to III injuries and a small to moderate hemoperitoneum. These patients should require no more than 2 U of blood, and repeat scans should demonstrate a stable injury.
对63例连续性钝性肝损伤患者进行了检查。24例患者接受了急诊手术，39例患者接受了计算机断层扫描（CT）评估，其中17例接受了手术。10例患者CT检查显示肝脏无异常，因合并伤接受了手术。其余7例患者发现有肝损伤，但CT低估了4例患者的损伤程度。CT显示所有7例患者均有大量腹腔积血，初始复苏期间平均输血量为10单位。22例Ⅰ至Ⅲ级损伤且腹腔积血少量至中等量的患者接受了非手术治疗。其中6例患者在复苏期间接受了输血。只有1例患者输血超过2单位。未发生与肝损伤相关的死亡和严重并发症。大多数患者在1周时进行了重复CT检查，结果显示损伤稳定或有所改善。CT可能会低估肝损伤的程度。对于Ⅰ至Ⅲ级损伤且腹腔积血少量至中等量的稳定患者，非手术治疗是合适的。这些患者所需输血量应不超过2单位，重复扫描应显示损伤稳定。
