Hiatt J R, Harrier H D, Koenig B V, Ransom K J
Trauma and Emergency Surgery Service, UCLA Medical Center 90024.
Arch Surg. 1990 Jan;125(1):101-3. doi: 10.1001/archsurg.1990.01410130107016.
We evaluated the role of nonoperative therapy in 16 patients with blunt multisystem trauma, hemodynamic stability following resuscitation, and major lobar liver injury; the patients were treated with a protocol of intensive care unit observation and computed tomographic scanning to identify and follow up the hepatic lesion. Computed tomographic scans showed right-lobe or bilobar liver lacerations and/or subcapsular hematomas in all patients and associated hemoperitoneum in 8 patients. Exploration was required in 2 patients; both were found to have a hemoperitoneum and a nonbleeding liver laceration. There were no deaths. Patients with hemoperitoneum requiring transfusion had significantly greater injury severity scores and longer intensive care unit and hospital stays. The major advantage of a nonoperative approach is the opportunity to stabilize major extra-abdominal (particularly head) injuries as the first priority. Unstable hemodynamics, abdominal distension, and falling hematocrit are indications for prompt exploration. Nonoperative care of these injuries requires a strict treatment protocol.
我们评估了非手术治疗在16例钝性多系统创伤、复苏后血流动力学稳定且伴有主要肝叶损伤患者中的作用；这些患者接受了重症监护病房观察及计算机断层扫描方案，以识别并随访肝脏损伤情况。计算机断层扫描显示，所有患者均有右叶或双叶肝裂伤和/或肝包膜下血肿，8例患者伴有腹腔积血。2例患者需要进行探查；二者均发现有腹腔积血及无出血的肝裂伤。无死亡病例。需要输血的腹腔积血患者损伤严重程度评分显著更高，在重症监护病房和医院的住院时间更长。非手术治疗方法的主要优势在于有机会将稳定主要的腹部外（尤其是头部）损伤作为首要任务。血流动力学不稳定、腹胀及血细胞比容下降是迅速进行探查的指征。对这些损伤进行非手术治疗需要严格的治疗方案。
