Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
Department of Studies and Research, Aix-Marseille Université, Marseille, France.
Updates Surg. 2022 Dec;74(6):1901-1913. doi: 10.1007/s13304-022-01367-6. Epub 2022 Aug 28.
Non-operative management (NOM) has become the major treatment of blunt liver trauma (BLT) with a NOM failure rate of 3-15% due to liver-related complications. The aim of the study was to determine the predictive factors and a risk-stratified score of NOM failure. From 2013 to 2021, all patients with BLT in three trauma centers were included; clinical, biological, radiological and outcome data were retrospectively analyzed. Predictive factors and a risk-stratified score associated with NOM failure were identified. Four hundred and ninety-four patients with BLT were included. Among them, 80 (16.2%) had isolated BLT. Fifty-nine patients (11.9%) underwent emergent operative management (OM) on the day of admission and 435 (88.1%) had a NOM. NOM failure rate was 11.5%. Patients with a NOM failure more frequently had a hemoperitoneum (p < 0.001), liver bleeding (p < 0.001), blood transfusion (p < 0.001) and angioembolization (p < 0.001) compared to patient with a successful NOM. In multivariate analysis, the presence of hemoperitoneum (OR = 5.71; 95 CI [1.29-25.45]), angioembolization (OR = 8.73; 95 CI [2.04-38.44] and severe liver injury (AAST IV or V) (OR = 8.97; 95 CI [3.36-23.99]) were independent predictive factors of NOM failure. When these three factors were associated, NOM failure rate was 83.3%. The AAST grade, the presence of hemoperitoneum and the realization of liver angioembolization on the day of admission are three independent predictive factors of NOM failure. Our risk-score based on these three factors stratify the risk of NOM failure in BLT and could be used for a more appropriate level of medical survey adapted to each patient. Level of evidence: prospective observational cohort study, Level III.
非手术治疗（NOM）已成为钝性肝外伤（BLT）的主要治疗方法，但由于与肝脏相关的并发症，NOM 失败率为 3-15%。本研究旨在确定 NOM 失败的预测因素和风险分层评分。2013 年至 2021 年，纳入三家创伤中心的所有 BLT 患者；回顾性分析临床、生物学、影像学和结局数据。确定与 NOM 失败相关的预测因素和风险分层评分。共纳入 494 例 BLT 患者。其中，80 例（16.2%）为孤立性 BLT。59 例（11.9%）在入院当天接受紧急手术治疗（OM），435 例（88.1%）接受 NOM。NOM 失败率为 11.5%。与成功接受 NOM 的患者相比，NOM 失败的患者更常出现血腹（p<0.001）、肝出血（p<0.001）、输血（p<0.001）和血管栓塞（p<0.001）。多变量分析显示，血腹（OR=5.71；95%CI[1.29-25.45]）、血管栓塞（OR=8.73；95%CI[2.04-38.44]）和严重肝损伤（AAST IV 或 V）（OR=8.97；95%CI[3.36-23.99]）是 NOM 失败的独立预测因素。当这三个因素相关时，NOM 失败率为 83.3%。入院时 AAST 分级、血腹和肝血管栓塞的存在是 NOM 失败的三个独立预测因素。我们基于这三个因素的风险评分可对 BLT 的 NOM 失败风险进行分层，并可用于对每个患者进行更合适的医疗调查水平。证据水平：前瞻性观察队列研究，III 级。
