Sikhondze W L, Madiba T E, Naidoo N M, Muckart D J J
Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban, South Africa.
Injury. 2007 Jan;38(1):65-70. doi: 10.1016/j.injury.2006.08.064. Epub 2006 Nov 13.
Severe bleeding from liver injury is one of the major causes of mortality in patients with abdominal trauma. The study was undertaken to assess factors that influence outcome following liver trauma.
This is a prospective study of patients with liver injury treated in one surgical ward at King Edward VIII Hospital over a 7-year period (from 1998 to 2004). Data collected included demographics, intra-operative findings, operative management and outcome.
Of a total of 478 patients with abdominal trauma, 105 (22%) were found to have liver injuries, of whom only 7 were female. Their mean age was 27.81+/-10.33 years. Injuries were due to firearms (70), stabs (26) and blunt trauma (9). Nineteen patients presented with shock (systolic BP<or=90 mmHg). All patients underwent laparotomy. Delay before surgery was <or=6h in 58 patients and >6h in 47 patients. Forty patients required ICU management (38%) and the mean ICU stay was 6.55+/-5.65 days. Twenty patients (19%) needed a re-laparotomy for various reasons. The complication rate was 37% and the mortality rate was 20% (23% for firearms, 44% for blunt trauma and 4% for stabs). The mortality rate in patients with shock was 58% compared to 12% in those who were not shocked (p<0.0001). Mortality rate was 2, 23 and 63% for Injury Severity Score (ISS)<or=9, 10-20 and >20, respectively (group 1 versus group 2 p=0.015; group 1 versus group 3 p<0.0001 and group 2 versus group 3 p=0.001). Mortality rates for delay <or=6h and delay >6h were 28 and 9%, respectively (p=0.008). Associated injuries led to a higher mortality (3% versus 27%; p=0.006). Hospital stay was 11.27+/-12.09 days.
Liver injuries occurred in 22% of abdominal injuries. Injury mechanism, delay before surgery, shock on admission, grade of injury, associated injury and ISS are significantly associated with outcome.
肝损伤导致的严重出血是腹部创伤患者死亡的主要原因之一。本研究旨在评估影响肝创伤预后的因素。
这是一项对在爱德华八世国王医院一个外科病房接受治疗的肝损伤患者进行的前瞻性研究，研究时间跨度为7年（从1998年至2004年）。收集的数据包括人口统计学信息、术中发现、手术管理及预后情况。
在总共478例腹部创伤患者中，发现105例（22%）有肝损伤，其中仅7例为女性。他们的平均年龄为27.81±10.33岁。损伤原因包括火器伤（70例）、刺伤（26例）和钝性创伤（9例）。19例患者出现休克（收缩压≤90mmHg）。所有患者均接受了剖腹手术。58例患者手术前延迟时间≤6小时，47例患者手术前延迟时间>6小时。40例患者需要重症监护病房（ICU）管理（38%），平均ICU住院时间为6.55±5.65天。20例患者（19%）因各种原因需要再次剖腹手术。并发症发生率为37%，死亡率为20%（火器伤为23%，钝性创伤为44%，刺伤为4%）。休克患者的死亡率为58%，未休克患者的死亡率为12%（p<0.0001）。损伤严重程度评分（ISS）≤9、10 - 20和>20的患者死亡率分别为2%、23%和63%（第1组与第2组比较，p = 0.015；第1组与第3组比较，p<0.0001；第2组与第3组比较，p = 0.001）。手术前延迟时间≤6小时和>6小时的患者死亡率分别为28%和9%（p = 0.008）。合并其他损伤导致更高的死亡率（3%对27%；p = 0.006）。住院时间为11.27±12.09天。
22%的腹部损伤患者存在肝损伤。损伤机制、手术前延迟时间、入院时休克、损伤程度、合并其他损伤及ISS与预后显著相关。
