Fabian T C, Croce M A, Stanford G G, Payne L W, Mangiante E C, Voeller G R, Kudsk K A
Department of Surgery, University of Tennessee, Memphis.
Ann Surg. 1991 Jun;213(6):540-7; discussion 548. doi: 10.1097/00000658-199106000-00003.
During a 5-year period, 482 patients with liver injuries were studied prospectively: 65% resulted from penetrating and 35% from blunt injuries. The injuries were graded by the hepatic injury scale (grades I to VI); transfusion requirements and perihepatic abscesses correlated with increasing scores. Minor surgical techniques were needed in 338 patients and 144 patients required major techniques. Omental packing was used in 60% of the major injuries and yielded 7% mortality and 8% abscess rates. Gauze packs were used for management of 10% of major injuries and yielded 29% mortality and 30% abscess rates. The patients were randomized to no drain, closed suction, or sump drainage and respective perihepatic abscess rates were 6.7%, 3.5%, and 13% (p less than 0.03; suction compared to closed suction). Multivariate analysis demonstrated increasing abdominal trauma indices and transfusion requirements as well as sump drainage to be associated independently with perihepatic infection.
在5年期间，对482例肝损伤患者进行了前瞻性研究：65%的损伤由穿透伤引起，35%由钝性伤引起。损伤按肝损伤分级标准（I至VI级）进行分级；输血需求和肝周脓肿与评分增加相关。338例患者需要采用小型手术技术，144例患者需要采用大型手术技术。60%的严重损伤采用网膜填塞法，死亡率为7%，脓肿发生率为8%。10%的严重损伤采用纱布填塞法治疗，死亡率为29%，脓肿发生率为30%。患者被随机分为不置引流管、闭式吸引或负压引流组，各自的肝周脓肿发生率分别为6.7%、3.5%和13%（P<0.03；负压引流与闭式吸引相比）。多变量分析表明，腹部创伤指数增加、输血需求增加以及负压引流与肝周感染独立相关。
