Saba University School of Medicine, The Bottom, Caribbean Netherlands, the Netherlands.
Surgeon. 2020 Jun;18(3):165-177. doi: 10.1016/j.surge.2019.07.001. Epub 2019 Aug 6.
The liver is the most frequently damaged organ in blunt abdominal trauma. It is widely accepted that hemodynamically stable patients with low-grade liver trauma should be treated with non-operative management, however there is controversy surrounding its safety and efficacy in high-grade trauma. The purpose of this review is to investigate the role of non-operative management in patients with high-grade liver trauma.
PubMed and reference lists of PubMed articles were searched to find studies that examined the efficacy of non-operative management in high-grade liver injury patients, and compare it to operative management. Non-operative management was considered successful if rescue surgery was avoided. Outcomes considered were success, mortality, and complication rates.
The electronic search revealed 2662 records, 8 of which met the inclusion criteria. All 8 studies contained results suggesting that non-operative management was safe and effective in hemodynamically stable patients with high-grade liver trauma. By combining the outcomes of the different studies, non-operative management had a high success rate of 92.4% (194/210) in high-grade liver trauma patients, which was near the overall 95.0% non-operative management success rate. Non-operative management also had mortality and complication rates of 4.6% (9/194) and 9.7% (7/72) in high-grade injury patients, respectively, compared to operative management's 17.6% (26/148) and 45.5% (5/11).
Non-operative management of liver trauma is safe and effective in hemodynamically stable patients with high-grade liver injury. It is associated with significantly lower mortality compared with operative management. More studies are required to evaluate complications of non-operative management in high-grade liver injury.
肝脏是钝性腹部创伤中最常受损的器官。人们普遍认为，血流动力学稳定、低级别肝外伤患者应采用非手术治疗，但在高级别创伤中，其安全性和疗效仍存在争议。本综述的目的是探讨非手术治疗在高级别肝外伤患者中的作用。
检索 PubMed 数据库和 PubMed 文章的参考文献列表，寻找评估非手术治疗在高级别肝损伤患者中的疗效，并与手术治疗进行比较的研究。如果避免了抢救性手术，则认为非手术治疗成功。评估的结果包括成功率、死亡率和并发症发生率。
电子检索显示有 2662 条记录，其中 8 条符合纳入标准。这 8 项研究均表明，血流动力学稳定的高级别肝外伤患者采用非手术治疗是安全有效的。通过合并不同研究的结果，非手术治疗在高级别肝外伤患者中的成功率为 92.4%（194/210），接近非手术治疗的总体成功率 95.0%。非手术治疗的死亡率和并发症发生率分别为高级别损伤患者的 4.6%（9/194）和 9.7%（7/72），而手术治疗的死亡率和并发症发生率分别为 17.6%（26/148）和 45.5%（5/11）。
非手术治疗血流动力学稳定的高级别肝外伤患者是安全有效的。与手术治疗相比，它的死亡率显著降低。需要更多的研究来评估高级别肝损伤中非手术治疗的并发症。
