Kartal Research and Education Hospital, Turkey.
Kartal Research and Education Hospital, Turkey.
Int J Surg. 2017 Mar;39:255-259. doi: 10.1016/j.ijsu.2017.02.015. Epub 2017 Feb 11.
Liver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates.
Patients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003 and 2013. Patient demographics, hepatic panel, APTT (activated partial thromboplastin time), PT (prothrombin time), INR (international normalized ratio), fibrinogen, biochemistry panel were recorded. Hemodynamic instability was the most prominent factor for surgery decision, in the lead of current Advanced Trauma Life Support (ATLS) protocols. Operation records and imaging modalities revealed liver injuries according to the Organ Injury Scale of the American Association for the Surgery of Trauma. 300 patients admitted to emergency department were included in our study (187 males and 113 females). Mean age was 47 years (range, 12-87). The overall mortality rate was 13% (40 out of 300). Major factor responsible for mortality rates and outcome was stability of cases on admission. 188 (% 63) patients were counted as stable, whereas 112 (% 37) cases were found unstable (blood pressure ≤ 90, after massive resuscitation). 192 patients were observed conservatively, whereas 108 cases received abdominal surgery. High levels of AST, ALT, LDH, INR, creatinine and low levels of fibrinogen and low platelet counts on admission were found to be associated with mortality and these cases also had Grade 4 and 5 injuries. Hemodynamic instability on admission and the type and grade of injury played major role in mortality rates). Packing was performed in 35 patients, with Grade 4 and 5 injuries. Mortality rate was %13 (40 out of 300).
A multidisciplinary approach to the management of hepatic injuries has evolved over the last few decades, but the basic principles of trauma continue to be observed. Diagnostic and therapeutic endeavors are chosen based mainly on the stability of the patient. Stable patients with reliable examinations and available resources can be managed nonoperatively. Unstable patients require surgery. Our current approach to liver traumas is non operative technique, if possible.
由于肝脏的大小和位置，肝脏损伤仍然是成功治疗的主要障碍。手术的需求应根据临床因素确定，最重要的是血流动力学状态。在本研究中，我们尝试阐明我们对肝脏外伤的处理方法。我们还强调了保守治疗的重要性，因为肝脏外伤手术的死亡率很高。
2003 年至 2013 年间，回顾性分析了因肝外伤入住 Kartal 研究与教育医院急诊外科的患者。记录了患者的人口统计学资料、肝酶谱、APTT（部分凝血活酶时间）、PT（凝血酶原时间）、INR（国际标准化比值）、纤维蛋白原、生化谱。根据当前先进创伤生命支持（ATLS）协议，血流动力学不稳定是手术决策的最主要因素。手术记录和影像学检查根据美国创伤外科学会的器官损伤分级显示肝脏损伤。我们的研究纳入了 300 名入住急诊科的患者（男 187 例，女 113 例）。平均年龄为 47 岁（范围 12-87 岁）。总体死亡率为 13%（40 例/300 例）。死亡率和结果的主要因素是入院时病例的稳定性。188 例（63%）患者被认为稳定，而 112 例（37%）患者不稳定（大量复苏后血压≤90）。192 例患者接受保守治疗，108 例患者接受腹部手术。入院时 AST、ALT、LDH、INR、肌酐水平升高，纤维蛋白原和血小板计数降低与死亡率相关，这些患者的损伤程度为 4 级和 5 级。入院时血流动力学不稳定以及损伤的类型和程度对死亡率有重要影响）。35 例 4 级和 5 级损伤患者行填塞术，死亡率为 13%（40 例/300 例）。
在过去几十年中，对肝脏损伤的管理已经发展为多学科方法，但创伤的基本原理仍在继续观察。诊断和治疗努力主要基于患者的稳定性来选择。有可靠检查和可用资源的稳定患者可以进行非手术治疗。不稳定患者需要手术。我们目前对肝脏外伤的处理方法是非手术技术，如果可能的话。
