Li Petri Sergio, Gruttadauria Salvatore, Pagano Duilio, Echeverri Gabriel J, Di Francesco Fabrizio, Cintorino Davide, Spada Marco, Gridelli Bruno
Department of Abdominal and Transplantation Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, University of Pittsburgh Medical Center in Italy, Palermo, Italy.
Am Surg. 2012 Jan;78(1):20-5.
Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to V according to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.
复杂肝脏创伤常常带来重大的诊断和治疗难题。当前的手术治疗主要集中在填塞、损伤控制以及早期利用介入放射学进行血管造影和栓塞。在这项对1999年至2010年期间入住意大利巴勒莫地中海移植与高级专科治疗研究所的患者进行的回顾性观察研究中，我们纳入了因复杂肝脏损伤（根据美国创伤外科学会器官损伤分级标准为I至V级）而接受肝切除术的患者。分析的变量包括年龄、性别、创伤机制、切除类型、手术并发症、住院时间和死亡率。共有53例成年肝脏损伤患者入院，其中29例接受了手术治疗；中位年龄为26.7岁。52例患者的创伤机制为钝性伤。总体发病率为30%，与肝切除相关的发病率为15.3%。在因复杂肝脏损伤接受肝切除术的患者系列中，死亡率为2%，而在非手术组中，发病率为17%，死亡率为2%。对于复杂肝脏损伤患者，肝切除术应被视为一种严肃的手术选择，无论是作为初始治疗还是延迟治疗，并且在专业肝脏手术/移植中心进行时，可实现较低的死亡率和与肝脏相关的发病率。
