Hammond J C, Canal D F, Broadie T A
Department of Surgery, Wishard Memorial Hospital, Indiana University School of Medicine, Indianapolis 46202.
Am Surg. 1992 Sep;58(9):551-5; discussion 555-6.
While nonoperative management of blunt hepatic trauma has become the standard of care in children, its use in the adult population is not as well accepted. The purpose of this study was for the authors to review their experience with operative and nonoperative management of adults with blunt hepatic trauma at an urban trauma center. During the past 7 years, 56 adults were found on abdominopelvic computerized tomography or at exploratory laparotomy to have sustained blunt hepatic trauma. Nonoperative management was considered in patients who were hemodynamically stable; had no signs of peritoneal irritation; and had no other intra-abdominal injuries that might require surgical repair. Of the 56 patients, 20 were admitted to the surgical intensive care unit for careful observation. One patient required the administration of blood products and a second underwent laparotomy within 12 hours of presentation for progressive abdominal pain. This patient had a 4-cm liver laceration easily controlled with electrocautery. This review supports the judicious application of nonoperative management in the hemodynamically stable adult with blunt hepatic trauma who is without signs of significant peritoneal irritation or other intra-abdominal injuries that would require surgical repair.
虽然钝性肝外伤的非手术治疗已成为儿童治疗的标准方法，但在成人患者中的应用尚未得到广泛认可。本研究的目的是让作者回顾他们在城市创伤中心对钝性肝外伤成人患者进行手术和非手术治疗的经验。在过去7年中，通过腹部盆腔计算机断层扫描或剖腹探查发现56例成人遭受钝性肝外伤。血流动力学稳定、无腹膜刺激征且无其他可能需要手术修复的腹腔内损伤的患者被考虑进行非手术治疗。56例患者中，20例被收入外科重症监护病房进行密切观察。1例患者需要输注血液制品，另1例患者在就诊后12小时内因进行性腹痛接受了剖腹手术。该患者有一处4厘米的肝裂伤，用电灼法很容易控制。本综述支持对血流动力学稳定、无明显腹膜刺激征或其他需要手术修复的腹腔内损伤的钝性肝外伤成人患者谨慎应用非手术治疗。
