Division of Visceral-, Transplantation-, Thoracic- and Vascular- Surgery, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Langenbecks Arch Surg. 2010 Apr;395(4):381-6. doi: 10.1007/s00423-009-0566-9. Epub 2009 Nov 12.
Hepatic trauma is a rare surgical emergency with significant morbidity and mortality. Therapeutic strategies have been controversially discussed during the last decades.
The medical records of 47 consecutive patients with hepatic trauma treated at the University Hospital of Leipzig between 2004 and 2008 were retrospectively reviewed for the severity of liver injury, management, morbidity, and mortality and compared to a preceding cohort. Logistic regression analysis was performed to identify risk factors influencing mortality.
Compared to 63 patients treated between 1993 and 2003, moderate liver injuries (grades I-III) occurred more frequently (p = 0.0006), and the proportion of patients that were managed operatively decreased from 68.9% to 37.5%. Twenty patients (42.6%) were treated conservatively (all grades I to III) and 27 surgically (47.4%). In detail, five patients were treated by hepatic packing alone, 13 by suture or coagulation, five by atypical resection, and four by hemihepatectomy. The overall mortality was 8.5% with a liver-related mortality rate of 2.1%. According to severity grades I-III, IV, and V, mortality rates were 0%, 18.2%, and 50.0%, respectively. Univariate analysis identified Injury Severity Score (ISS) >30, Moore grades IV and V, hemoglobin at admission <6.0 mmol/L, and need for transfusion of >12 erythrocyte concentrates to be significant risk factors for early posttraumatic death, while multivariate analysis only ISS >30 revealed to be of prognostic significance for early postoperative survival.
Compared to a previous cohort in the same hospital, more patients were treated conservatively. Management of liver injuries presented with a low liver-related mortality rate. Grades I-III injuries can safely be treated by conservative means with excellent results. However, complex hepatic injuries may often require surgical treatment ranging from packing to complex hemihepatectomy. Hence, for selection of appropriate therapeutic options, patients with hepatic injuries should be treated in a specialized institution.
肝外伤是一种罕见的外科急症，具有较高的发病率和死亡率。在过去几十年中，治疗策略一直存在争议。
回顾性分析了 2004 年至 2008 年莱比锡大学医院收治的 47 例肝外伤患者的病历，评估肝损伤严重程度、治疗方法、发病率和死亡率，并与前一组进行比较。采用逻辑回归分析确定影响死亡率的危险因素。
与 1993 年至 2003 年期间治疗的 63 例患者相比，中度肝损伤（I-III 级）更为常见（p = 0.0006），手术治疗的比例从 68.9%下降至 37.5%。20 例（42.6%）患者接受保守治疗（所有 I-III 级），27 例患者接受手术治疗（47.4%）。具体来说，5 例患者单独接受肝包扎治疗，13 例患者接受缝合或凝固治疗，5 例患者接受非典型性肝切除术，4 例患者接受半肝切除术。总体死亡率为 8.5%，与肝相关的死亡率为 2.1%。根据严重程度分级 I-III、IV 和 V，死亡率分别为 0%、18.2%和 50.0%。单因素分析发现损伤严重度评分（ISS）>30、摩尔分级 IV 和 V、入院时血红蛋白<6.0mmol/L 以及需要输注>12 单位红细胞浓缩物是早期创伤后死亡的显著危险因素，而多因素分析仅发现 ISS>30 是术后早期生存的预后意义。
与同一医院的前一组相比，更多的患者接受了保守治疗。肝损伤的治疗方法具有较低的肝相关死亡率。I-III 级损伤可安全地采用保守方法治疗，效果极佳。然而，复杂的肝损伤可能经常需要手术治疗，范围从填塞到复杂的半肝切除术。因此，为了选择合适的治疗方案，肝损伤患者应在专门机构接受治疗。
