Division of Trauma Surgery, Department of Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
World J Surg. 2012 Sep;36(9):2119-24. doi: 10.1007/s00268-012-1625-x.
Severe lesions in the liver are associated with a high mortality rate. Alternative surgical techniques such as the use of an intrahepatic balloon may be effective and reduce mortality in severe hepatic lesions. This study aimed to demonstrate the experience of a university hospital in the use of the Sengstaken-Blakemore balloon in patients with transfixing penetrating hepatic injury as an alternative way to treat these challenging injuries.
A retrospective study based on the trauma registry of a university hospital was performed. All patients admitted with hepatic penetrating injuries and treated with the Sengstaken-Blakemore balloon within the period 1990-2010 were reviewed.
Forty-six patients with transfixing hepatic injuries were treated with the Sengstaken-Blakemore balloon in the study period. The most frequent cause of injury was gunshot wound (87 % of the patients). The mean trauma scores on admission were Revised Trauma Score (RTS) = 7.12 ± 1.46, Injury Severity Score (ISS) = 22.4 ± 9.7, and Abdominal Trauma Index (ATI) = 19.5 ± 11. According to the severity of the hepatic trauma, 71.8 % of patients had grade III, 23.9 % grade IV, and 4.3 % grade V injuries. Associated abdominal injuries were found in 89.1 % of the patients. The most frequent liver-related complications were hepatic abscess postoperative bleeding (8.6 %), biliary fistula (8.6 %), (4.3 %), and biliary peritonitis (2.1 %). Surgical reintervention was necessary in 14 patients (31.1 %). From those 14, only 3 had the balloon removed. The overall morbidity and mortality rates were 56.5 % and 23.9 % (11 patients), respectively.
The knowledge of alternative surgical techniques is essential in improving survival in patients with severe penetrating hepatic injuries. The use of intrahepatic balloon is a viable surgical strategy.
肝脏严重损伤与高死亡率相关。替代手术技术，如使用肝内球囊，可能有效并降低严重肝损伤的死亡率。本研究旨在展示一所大学医院在使用 Sengstaken-Blakemore 球囊治疗穿透性肝损伤方面的经验，作为治疗这些挑战性损伤的替代方法。
对一所大学医院的创伤登记处进行回顾性研究。回顾了 1990 年至 2010 年期间，所有接受 Sengstaken-Blakemore 球囊治疗的穿透性肝损伤患者。
研究期间，46 例穿透性肝损伤患者接受了 Sengstaken-Blakemore 球囊治疗。最常见的损伤原因是枪伤（87%的患者）。入院时平均创伤评分（RTS）为 7.12 ± 1.46，损伤严重度评分（ISS）为 22.4 ± 9.7，腹部创伤指数（ATI）为 19.5 ± 11。根据肝损伤的严重程度，71.8%的患者为 III 级，23.9%为 IV 级，4.3%为 V 级。89.1%的患者合并腹部损伤。最常见的肝相关并发症为术后肝脓肿出血（8.6%）、胆瘘（8.6%）、（4.3%）和胆汁性腹膜炎（2.1%）。14 例患者需要再次手术干预（31.1%）。在这 14 例患者中，只有 3 例球囊被移除。总发病率和死亡率分别为 56.5%和 23.9%（11 例）。
了解替代手术技术对于提高严重穿透性肝损伤患者的生存率至关重要。肝内球囊的使用是一种可行的手术策略。
