Hulscher J B F, Labohm J, Goslings J C, van Lienden K P, Aronson D C
Kinderchirurgisch Centrum Amsterdam, Emma Kinderziekenhuis AMC, G8-238, Meibergdreef 9, 1105 AZ Amsterdam.
Ned Tijdschr Geneeskd. 2005 Dec 3;149(49):2705-11.
In 3 children, 2 boys aged 13 years and an 8-year-old girl, blunt trauma to the liver was diagnosed after a fall. The first patient underwent drainage of abdominal fluid collection on multiple occasions and a stent was introduced in the biliary duct to ensure normal bile flow; the second patient was treated by arterial catheter embolisation of a segmental branch of the right hepatic artery; in the third patient, acute laparotomy was performed in view ofhaemodynamic instability and a large hepatic rupture was treated by packing. All patients recovered successfully. In the paediatric population, blunt trauma to the liver requires a multidisciplinary approach. For haemodynamically stable children, a conservative course can be taken. Arterial embolisation is the treatment of choice if there is a persistent need for volume resuscitation or blood transfusion. In case of massive haemorrhagic shock, the child should undergo laparotomy, and if the bleeding cannot be stopped, the liver should be packed according to damage-control principles.
在3名儿童中,2名13岁男孩和1名8岁女孩,跌倒后被诊断为肝脏钝性创伤。第一名患者多次进行腹腔积液引流,并在胆管中置入支架以确保胆汁正常流动;第二名患者通过右肝动脉节段分支的动脉导管栓塞术进行治疗;第三名患者由于血流动力学不稳定接受了急诊剖腹手术,巨大肝破裂采用填塞法治疗。所有患者均成功康复。在儿科人群中,肝脏钝性创伤需要多学科方法。对于血流动力学稳定的儿童,可以采取保守治疗。如果持续需要容量复苏或输血,动脉栓塞是首选治疗方法。在发生大量出血性休克的情况下,儿童应接受剖腹手术,如果出血无法停止,应根据损伤控制原则对肝脏进行填塞。