Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
Department of Visceral Surgical Emergency, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):39-44. doi: 10.1016/j.hbpd.2018.01.013. Epub 2018 Jan 31.
The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five years.
The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were analyzed.
The study involved 83 patients, with a mean age of 33 years and a marked male predominance (85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries (81.9%) were of low severity (grades I, II, III), while 15 (18.1%) were of high severity (grade IV or greater). Fifty-six patients (67.5%) had multiple injuries. Surgical treatment was performed in 26 (31.3%) patients. Non-operative management was undertaken in 57 cases (68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated group.
Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.
肝脏是腹部创伤中最常受损的器官。在过去的二十年中，肝脏创伤的治疗经历了许多变化。目前，由于儿科成功经验和全球许多创伤中心记录的更好结果，非手术治疗趋势明显。本研究旨在评估我院近五年来肝外伤手术和非手术治疗的结果。
回顾性研究 2012 年 1 月至 2016 年 12 月期间我院收治的诊断为钝性或穿透性肝损伤的患者。根据患者入院时的初始治疗，将患者分为手术组和非手术组。分析临床特征和结局。
本研究共纳入 83 例患者，平均年龄 33 岁，男性明显居多（85.5%）。最常见的损伤类型为钝性损伤，主要原因为道路交通伤。68 例（81.9%）肝损伤程度较轻（Ⅰ、Ⅱ、Ⅲ级），15 例（18.1%）损伤程度较重（Ⅳ级或更严重）。56 例（67.5%）患者合并多发伤。26 例（31.3%）患者接受了手术治疗，57 例（68.7%）患者接受了非手术治疗。非手术治疗患者的发病率和死亡率明显低于手术组。
对于血流动力学稳定的肝外伤患者，仔细的非手术治疗是一种合理的治疗策略。对于合并复杂肝外伤，特别是合并其他器官损伤的患者，死亡率仍显著较高。
