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肝外伤的外科治疗:与住院时间相关的因素。

Surgical treatment in hepatic trauma: factors associated with hospitalization time.

机构信息

- Hospital Universitário Cajuru, Cirurgia Geral - Curitiba - PR - Brasil.

- Universidade Estadual do Oeste do Paraná, Curso de Medicina - Francisco Beltrão - PR - Brasil.

出版信息

Rev Col Bras Cir. 2021 Mar 24;48:e20202784. doi: 10.1590/0100-6991e-20202874. eCollection 2021.

Abstract

OBJECTIVE

the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma.

METHODS

retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program.

RESULTS

most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%.

CONCLUSIONS

the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.

摘要

目的

本研究旨在确定影响肝外伤手术患者住院时间延长的相关因素,以及死亡率的预测因素和该创伤的流行病学特征。

方法

对 2010 年至 2017 年期间在 Cajuru 大学医院接受治疗的 191 例多创伤患者进行回顾性研究,采用 STATA 版本 15.0 程序对其进行流行病学、临床病理和治疗变量分析。

结果

纳入的大多数患者为男性,平均年龄为 29 岁。火器伤是最常见的创伤机制。51.2%的病例为右肝叶损伤,肝修补术是最常用的手术矫正方法。平均住院时间为 11 天(0-78 天),重症监护病房住院时间为 5 天(0-52 天)。住院时间延长的预测因素包括创伤机制、入院时血流动力学不稳定、合并损伤数量、肝损伤程度和损伤部位、所使用的手术技术、是否存在并发症、是否需要再次手术和其他手术。死亡率为 22.7%。

结论

该研究证实了文献报道的肝外伤流行病学特征。肝外伤和合并损伤的严重程度是接受手术治疗的患者的特征,穿透性创伤、血流动力学不稳定、肝包裹、并发症和再次手术导致患者住院时间延长。

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本文引用的文献

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Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):39-44. doi: 10.1016/j.hbpd.2018.01.013. Epub 2018 Jan 31.
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Current approach to liver traumas.当前肝脏创伤的处理方法。
Int J Surg. 2017 Mar;39:255-259. doi: 10.1016/j.ijsu.2017.02.015. Epub 2017 Feb 11.
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Treatment of Liver Trauma: Operative or Conservative Management.肝外伤的治疗:手术治疗还是保守治疗。
Gastroenterology Res. 2010 Feb;3(1):9-18. doi: 10.4021/gr2010.02.165w. Epub 2010 Jan 20.
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Liver trauma: WSES position paper.肝外伤:世界急诊外科学会立场文件
World J Emerg Surg. 2015 Aug 25;10:39. doi: 10.1186/s13017-015-0030-9. eCollection 2015.
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Hepatic trauma: a 21-year experience.肝外伤:21年的经验总结。
Rev Col Bras Cir. 2013 Jul-Aug;40(4):318-22. doi: 10.1590/s0100-69912013000400011.
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[Morbimortality in patients with hepatic trauma].[肝外伤患者的病死情况]
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