Service of General Surgery, Trauma University Hospital, Tirana, Albania.
Department of Surgery, UHC "Mother Teresa", Tirana, Albania.
World J Emerg Surg. 2017 Jun 7;12:24. doi: 10.1186/s13017-017-0135-4. eCollection 2017.
The conservative treatment of liver trauma has made important progress over the last 10 years at the Trauma University Hospital in Tirana, Albania. The percentage of success was 58.7%. The aims of this study were to analyze the conservative treatment of liver trauma and to compare the results with those in the literature.
This study was conducted prospectively from January 2009 to December 2012. We analyzed 173 patients admitted to our hospital with liver trauma. Liver injuries were evaluated according to the American Association for the Surgery of Trauma and the World Society of Emergency Surgery classification, while the anatomic gravity of the associated injuries was defined using the Injury Severity Score system. The potential mortality was estimated with the Revised Trauma Score.
Out of the 173 patients with liver trauma, 83.2% were male. The main cause of liver trauma was motor vehicle crashes (50.9%). Blunt trauma was the cause of liver injury in 129 cases (74.6%), and penetrating trauma occurred in 44 cases (25.4%). Initially, the decision was to manage 88 cases (50.9%) via the conservative approach. Of these, 73 cases (42.2%) were successfully treated with conservative treatment, while in 15 cases (17.2%), this approach failed. The success rate of conservative treatment by grade of injuries was as follows: grade I (38.4%), grade II (30.1%), grade III (28.8%), and grade IV (2.7%). The likelihood of the success of conservative treatment had a significant correlation with the grade of the liver injury ( < 0.00001), associated intra-abdominal injuries ( = 0.00051), and complications ( = 2.3169, = 0.02051). The overall mortality rate of liver trauma was 13.2%.
The likelihood of success in using conservative treatment had a significant correlation with the grade of liver injury and associated intra-abdominal injuries. The limited hospital resources and low level of consensus on conservative treatment had a negative impact on the level of success.
过去 10 年来，在阿尔巴尼亚地拉那创伤大学医院，肝外伤的保守治疗取得了重要进展。成功率为 58.7%。本研究旨在分析肝外伤的保守治疗，并与文献中的结果进行比较。
本研究于 2009 年 1 月至 2012 年 12 月进行前瞻性研究。我们分析了我院收治的 173 例肝外伤患者。根据美国创伤外科学会和世界急诊外科学会分类评估肝损伤，采用损伤严重度评分系统定义相关损伤的解剖严重程度。采用修订后的创伤评分估计潜在死亡率。
173 例肝外伤患者中，83.2%为男性。肝外伤的主要原因是机动车事故（50.9%）。钝性损伤导致 129 例（74.6%）肝损伤，44 例（25.4%）为穿透性损伤。最初，决定对 88 例（50.9%）患者采用保守治疗。其中，73 例（42.2%）成功采用保守治疗，15 例（17.2%）治疗失败。损伤程度分级的保守治疗成功率如下：Ⅰ级（38.4%）、Ⅱ级（30.1%）、Ⅲ级（28.8%）和Ⅳ级（2.7%）。保守治疗成功率与肝损伤程度（ < 0.00001）、合并腹腔内损伤（ = 0.00051）和并发症（ = 2.3169， = 0.02051）显著相关。肝外伤的总死亡率为 13.2%。
保守治疗成功的可能性与肝损伤程度和合并腹腔内损伤显著相关。有限的医院资源和对保守治疗的共识水平低对治疗效果产生负面影响。
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