Jung Kyoungwon, Kim Younghwan, Heo Yunjung, Lee John Cook-Jong, Youn SeokHwa, Moon Jonghwan, Kim Jiyoung, Kim Tea-Youn, Kim Bongwan, Wang Heejung
Hepatogastroenterology. 2015 Mar-Apr;62(138):410-6.
BACKGROUND/AIMS: This study was conducted to investigate effective management strategies for patients with severe blunt liver injuries.
Treatment methods and outcomes of 77 patients with grade IV-V damage among patients with liver injury managed between 2009 and 2013 were investigated.
Of the 77 patients, 32 were managed surgically. Packing was performed in 29 of these patients, while 26 also underwent liver surgery to maximize the hemostatic effect of packing. All 32 underwent temporary abdominal closure, and the mean amount of blood products used in the first 24 hours after admission included packed red blood cell, 13.3 units; fresh frozen plasma, 12.4 units; and platelets, 12.2 units, very close to 1:1:1. A total of 9 of 77 (11.7%) patients and 8 of 32 who underwent the operation died (operative mortality rate, 25%). Liver-related uncontrolled hemorrhage contributing to death occurred in four patients (12.5%).
Although nonoperative management can first be pursued if the patient's condition allows for it, hemodynamic instability and evidence of peritonitis requires surgical management. Surgical management should abide by the damage control surgery principles that focus on packing to minimize surgical time, followed by aggressive critical care according to damage control resuscitation.
背景/目的：本研究旨在探讨严重钝性肝损伤患者的有效管理策略。
对2009年至2013年期间接受治疗的肝损伤患者中77例IV - V级损伤患者的治疗方法及结果进行调查。
77例患者中，32例行手术治疗。其中29例进行了填塞，26例还接受了肝脏手术以增强填塞的止血效果。所有32例均进行了临时腹壁关闭，入院后最初24小时使用的血液制品平均量包括浓缩红细胞13.3单位、新鲜冰冻血浆12.4单位和血小板12.2单位，非常接近1:1:1。77例患者中有9例（11.7%）死亡，32例接受手术治疗的患者中有8例死亡（手术死亡率为25%）。因肝脏相关出血无法控制导致死亡的有4例（12.5%）。
如果患者情况允许，首先可采用非手术治疗，但血流动力学不稳定和腹膜炎证据则需要手术治疗。手术治疗应遵循损伤控制手术原则，重点是进行填塞以尽量缩短手术时间，随后根据损伤控制复苏进行积极的重症监护。
