Kasai T, Kobayashi K
Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 Apr;90(4):532-7.
From our experiences, the causes of high mortality rate in hepatectomy for hepatic rupture may be attributed to improper application of this procedure to trauma victims under suboptimal conditions, as most of the deaths were related to coagulopathy and uncontrollable bleeding. Accordingly, a protocol of indication for emergent hepatectomy was established in March, 1985, which included the following criteria: PH greater than 7.2, body temperature greater than 32.0 degrees C, systolic blood pressure greater than 60mmHg and no presence of coagulopathy. Of 14 cases which underwent hepatectomy before March, 1985, 9 cases died of exsanguination, coagulopathy and multiple organ failure with the mortality rate of 63.7% whereas only two of 10 cases which underwent hepatectomy after March, 1985, died, the mortality rate being markedly decreased to 20%. Considering the fact that there were no differences between these two groups of the patients regarding severity of liver trauma and clinical back ground, it indicates that the appropriate selection of the patients for hepatectomy based on the criteria has definitely decreased the mortality rate of hepatic rupture victims.
根据我们的经验，肝破裂肝切除术死亡率高的原因可能是该手术不适当地应用于条件欠佳的创伤患者，因为大多数死亡与凝血功能障碍和无法控制的出血有关。因此，1985年3月制定了紧急肝切除术的适应证方案，其中包括以下标准：pH值大于7.2，体温大于32.0摄氏度，收缩压大于60mmHg且无凝血功能障碍。1985年3月前接受肝切除术的14例患者中，9例死于失血性休克、凝血功能障碍和多器官功能衰竭，死亡率为63.7%；而1985年3月后接受肝切除术的10例患者中仅2例死亡，死亡率显著降至20%。考虑到这两组患者在肝外伤严重程度和临床背景方面并无差异，这表明根据该标准适当选择肝切除术患者确实降低了肝破裂患者的死亡率。
