严重肝损伤的外科治疗：单中心经验。

Surgical treatment for severe liver injuries: a single-center experience.

机构信息

Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania.

Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.

出版信息

Minerva Chir. 2020 Apr;75(2):92-103. doi: 10.23736/S0026-4733.20.08193-6. Epub 2020 Jan 29.

DOI:10.23736/S0026-4733.20.08193-6

PMID:32009332

Abstract

BACKGROUND

The liver is one of the most frequently injured organs in abdominal trauma. The advancements in diagnosis and interventional therapy shifted the management of liver trauma towards a non-operative management (NOM). Nevertheless, in severe liver injuries (LI), surgical treatment often involving liver resection (LR) and rarely liver transplantation (LT) remains the main option. The present paper analyses a single center experience in a referral HPB center on a series of patients with high-grade liver trauma.

METHODS

Forty-five patients with severe LI, that benefitted from NOM (6 pts), LRs (38 pts), and LT (1 pt) performed in our center between June 2000 and June 2019, were included in a combined prospective and retrospective study. The median age of the patients was 29 years (median 33, range 10-76), and the male/female ratio of 33/12. Almost all cases had blunt trauma, except 2 with stab wound (4.4%).

RESULTS

LIs classified according to the American Association for the Surgery of Trauma (AAST) system were 13.3% (grade III), 44.2% (grade IV), and 42.2% (grade V); none were grade I, II or VI. The rate of major LR was 56.4% (22 LRs). The median operative time was 200 minutes (mean 236; range 150-420). The median blood loss was 750 ml (mean 940; range 500-6500). Overall and major complication rates were 100% (45 pts) and 33.3% (15 pts), respectively. Overall mortality rate was 15.6% (7 pts).

CONCLUSIONS

Severe liver trauma, often involving complex liver resections, should be managed in a referral HPB center, thus obtaining the best results in terms of morbidity and mortality.

摘要

背景

肝脏是腹部创伤中最常受伤的器官之一。诊断和介入治疗的进步使肝脏创伤的治疗转向非手术治疗（NOM）。然而，在严重的肝损伤（LI）中，手术治疗，包括肝切除术（LR）和很少的肝移植（LT），仍然是主要选择。本文分析了一家转诊肝胆中心在一系列高等级肝外伤患者中的单中心经验。

方法

2000 年 6 月至 2019 年 6 月期间，我院对 45 例严重 LI 患者（6 例接受 NOM，38 例接受 LR，1 例接受 LT）进行了前瞻性和回顾性联合研究。患者的中位年龄为 29 岁（范围 10-76 岁，中位数 33 岁），男女比例为 33/12。除 2 例外，所有病例均为钝性创伤，其余 2 例为刺伤（4.4%）。

结果

根据美国创伤外科学会（AAST）系统对 LI 进行分类，3 级 13.3%（III 级），4 级 44.2%（IV 级），5 级 42.2%（V 级）；无 I、II 或 VI 级。主要 LR 率为 56.4%（22 例 LR）。手术时间中位数为 200 分钟（均值 236；范围 150-420）。中位出血量为 750ml（均值 940；范围 500-6500）。总并发症发生率和主要并发症发生率分别为 100%（45 例）和 33.3%（15 例）。总死亡率为 15.6%（7 例）。