Li Min, Yu Wen-Kui, Wang Xin-Bo, Ji Wu, Li Jie-Shou, Li Ning
Department of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China.
Hepatobiliary Pancreat Dis Int. 2014 Oct;13(5):545-50. doi: 10.1016/s1499-3872(14)60049-7.
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
肝外伤是最常见的腹部急症，发病率和死亡率都很高。目前，非手术治疗（NOM）是肝外伤的一种选择性治疗方法。本研究的目的是确定NOM治疗单纯性肝外伤的成功率、死亡率和发病率。我们回顾性分析了本单位81例单纯性肝外伤患者的病历，评估了NOM的成功率、死亡率和发病率。在该系列中，9例IV-V级肝损伤患者因血流动力学不稳定接受了急诊手术；72例血流动力学稳定的患者接受了NOM，其中V级6例、IV级18例、III级29例、II级15例、I级4例。NOM的总体成功率为97.2%（70/72）。I-III级、IV级和V级肝外伤患者NOM的成功率分别为100%、94.4%和83.3%。接受NOM和手术治疗的患者并发症发生率分别为10.0%和45.5%。I-II级肝外伤患者均无并发症发生。所有接受NOM治疗的患者均存活。如果患者血流动力学稳定，NOM是肝外伤治疗的首选。肝损伤分级和腹腔积血量不是选择NOM的合适标准。肝血管栓塞联合纠正体温过低、凝血功能障碍和酸中毒在肝外伤的保守治疗中很重要。
