Fisher Jason C, Moulton Steven L
Division of Surgery, Section of Pediatric Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
J Pediatr Surg. 2004 Apr;39(4):619-22. doi: 10.1016/j.jpedsurg.2003.12.024.
The authors report the case of a grade 4 liver laceration caused by blunt abdominal trauma. The liver injury was managed nonoperatively, both initially and after an episode of delayed hemorrhage. The patient suffered 2 additional as yet unreported complications of pediatric liver injury: a right pleural effusion causing respiratory embarrassment followed by duodenal obstruction; the latter was caused by hypertrophy of the left lobe of the liver. Although numerous reports suggest that delayed hemorrhage after pediatric liver injury should be managed operatively, the mortality of such intervention remains high, reaffirming the dictum that one must treat the patient and not the injury.
作者报告了一例因钝性腹部创伤导致的4级肝裂伤病例。该肝损伤最初以及在发生延迟性出血后均采用非手术治疗。该患者还出现了另外2种尚未报道的小儿肝损伤并发症：右胸腔积液导致呼吸窘迫，随后出现十二指肠梗阻；后者是由肝左叶肥大引起的。尽管许多报告表明小儿肝损伤后的延迟性出血应采用手术治疗，但这种干预的死亡率仍然很高，这再次证明了必须治疗患者而非仅仅治疗损伤这一格言。
