Smaniotto Benjamin, Bahten Luiz Carlos Von, Nogueira Filho Dorivam Celso, Tano Agajanian Lumi, Thomaz Junior Laertes, Fayad Omar
Clinics and Surgery, PUC-PR, Brazil.
Rev Col Bras Cir. 2009 Jul;36(3):217-22.
The authors discuss the surgical strategies in the management of complex penetrating hepatic lesions through liver balloon tamponade.
Eighteen patients who received care in a trauma referral center in southern Brazil over the last 5 years were selected retrospectively. Data and variables evaluated were age, sex, hepatic injury grade and location, amount of saline solution filling the balloon and the length of time it was kept in place, associated injuries, the nutritional therapy instituted, hem concentrate transfusion, complications, antibiotics use, ICU need and length of hospital stay.
All patients were male with an average age of 22.5 years (18-48). Gunshot wounds were more prevalent than stab wounds and their most common locations were the thorax and thoraco-abdominal regions. The m most commonly associated injury was in the diaphragm, and Couinaud segment VIII was the most often injured hepatic region (29.6%). Seven patients (38.9%) survived and the most common complication were biliary fistulae (42.8%). From the eleven deceased patients (61.1%), 6 died on the day of admission, 3 stayed for 18.6 days in hospital and the others died on the 2nd and 3rd postoperative days.
Transfixing hepatic lesions are usually difficult to manage and carry high morbidity and mortality rates. The use of intrahepatic balloon tamponade can be useful as a therapeutic tool, but not rid of complications, and for that reason it has specific and selected indications.
作者探讨通过肝球囊填塞治疗复杂穿透性肝损伤的手术策略。
回顾性选取过去5年在巴西南部一家创伤转诊中心接受治疗的18例患者。评估的数据和变量包括年龄、性别、肝损伤分级和部位、球囊填充的盐水量及其留置时间、合并伤、所采用的营养治疗、浓缩红细胞输注、并发症、抗生素使用、是否需要入住重症监护病房及住院时间。
所有患者均为男性，平均年龄22.5岁（18 - 48岁）。枪伤比刺伤更常见，最常见的部位是胸部和胸腹区域。最常见的合并伤是膈肌损伤，肝Couinaud VIII段是最常受伤的肝区（29.6%）。7例患者（38.9%）存活，最常见的并发症是胆瘘（42.8%）。11例死亡患者（61.1%）中，6例在入院当天死亡，3例住院18.6天，其余在术后第2天和第3天死亡。
穿透性肝损伤通常难以处理，发病率和死亡率高。肝内球囊填塞作为一种治疗工具可能有用，但不能消除并发症，因此有特定的选择标准。
