Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
Scand J Surg. 2021 Jun;110(2):208-213. doi: 10.1177/1457496920921649. Epub 2020 Jul 21.
The trend in liver trauma management has progressively become increasingly conservative. However, a vast majority of literature focuses heavily on the management of blunt trauma. This study reviews the management of hepatic trauma at a major trauma center in a developing world setting, in order to compare blunt and penetrating liver trauma and to define current management algorithms and protocols.
All patients who sustained liver trauma between 2012 to 2018 were identified in the Hybrid Electronic Medical Registry and extracted for further analysis.
A total of 808 patients with hepatic trauma were managed by our trauma center. There were 658 males and 150 females. The mean age was 30 years (standard deviation 13.3). A total of 68 patients died (8.2%) and a total of 290 (35%) patients required intensive care unit admission. The mean presenting shock index was 0.806 (standard deviation 0.67-1.0), the median Injury Severity Score was 18 (interquartile range 10-25) and the mean Revised Trauma Score was 12 (standard deviation 11-12). There were 367 penetrating and 441 blunt liver injuries. The age distribution was similar in both groups. There were significantly less females in the penetrating group. The shock index and the Injury Severity Score on presentation were significantly worse in the blunt group, respectively: 0.891 (standard deviation 0.31) versus 0.845 (standard deviation 0.69) (p < 0.001) and score 21 (interquartile range 13-27) versus 16 (interquartile range 9-20) (p < 0.01). The opposite applied to the Revised Trauma Score of 11.75 (standard deviation 0.74) versus 11.19 (standard deviation 1.3) (p < 0.001). There were significantly more associated intra-abdominal injuries in the penetrating group than the blunt group, in particular that of hollow organs, and 84% of patients with a penetrating injury underwent a laparotomy while only 33% of the blunt injuries underwent a laparotomy. The mortality rate was comparable between both groups.
Hepatic trauma is still associated with a high morbidity rate, although there have been dramatic improvements in mortality rates over the last three decades. The mortality rates for blunt and penetrating liver trauma are now similar. Non-operative management is feasible for over two-thirds of blunt injuries and for just under 20% of penetrating injuries.
肝脏创伤管理的趋势已逐渐变得越来越保守。然而，绝大多数文献都侧重于钝性创伤的管理。本研究回顾了一家发展中国家的主要创伤中心的肝脏创伤管理，以便比较钝性和穿透性肝创伤，并定义当前的管理算法和方案。
从混合电子病历中确定了 2012 年至 2018 年期间发生的所有肝脏创伤患者，并进行了进一步分析。
我们的创伤中心共收治 808 例肝脏创伤患者。其中男性 658 例，女性 150 例。平均年龄为 30 岁（标准差 13.3）。共有 68 例死亡（8.2%），290 例（35%）患者需要入住重症监护病房。入院时的平均休克指数为 0.806（标准差 0.67-1.0），损伤严重度评分中位数为 18（四分位距 10-25），修订后的创伤评分平均值为 12（标准差 11-12）。穿透性肝损伤 367 例，钝性肝损伤 441 例。两组的年龄分布相似。穿透性组女性明显较少。入院时，钝性组的休克指数和损伤严重度评分明显更差，分别为 0.891（标准差 0.31）与 0.845（标准差 0.69）（p<0.001）和评分 21（四分位距 13-27）与 16（四分位距 9-20）（p<0.01）。相反，修订后的创伤评分分别为 11.75（标准差 0.74）与 11.19（标准差 1.3）（p<0.001）。穿透性组的腹腔内合并伤明显多于钝性组，尤其是中空器官的合并伤，84%的穿透性损伤患者接受了剖腹手术，而只有 33%的钝性损伤患者接受了剖腹手术。两组的死亡率相当。
尽管在过去三十年中，肝脏创伤的死亡率已有了显著的改善，但肝脏创伤仍然与高发病率有关。现在，钝性和穿透性肝创伤的死亡率相似。非手术治疗适用于超过三分之二的钝性损伤和近 20%的穿透性损伤。
