Dalcin R R, Petrillo Ytm, Alves Lac, Fonseca M K, Almeida A S, Corso C O
Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Hospital de Pronto Socorro de Porto Alegre, Brazil.
Ann R Coll Surg Engl. 2025 Feb;107(2):130-134. doi: 10.1308/rcsann.2022.0061. Epub 2024 May 24.
Experience accumulated over the last decades suggests nonoperative management (NOM) of civilian gunshot liver injuries can be safely applied in selected cases. This study aims to compare the outcomes of selective NOM versus operative management (OM) of patients sustaining gunshot wounds (GSW) to the liver.
A registry-based retrospective cohort analysis was performed for the period of 2008 to 2016 in a Brazilian trauma referral. Patients aged 16-80 years sustaining civilian GSW to right-sided abdominal quadrants and liver injury were included. Baseline data, vital signs, grade of liver injury, associated injuries, injury severity scores, blood transfusion requirements, liver- and non-liver-related complications, length-of-stay (LOS), and mortality were retrieved from individual registries.
A total of 54 patients were eligible for analysis, of which 37 underwent NOM and 17 underwent OM. The median age was 25 years and all were male. No statistically significant differences were observed between groups regarding patients' demographics, injury scores, grade of liver injury and associated lesions. NOM patients tended to sustain higher-grade injuries (86.5% vs 64.7%; = 0.08), and failure of conservative management was recorded in two (5.4%) cases. The rate of complications was 48% with no between-group statistically significant difference. Blood transfusion requirements were significantly higher in the OM group (58.8% vs 21.6%; = 0.012). The median LOS was seven days. No deaths were recorded.
Patients with liver GSW who are haemodynamically stable and without peritonitis are candidates for NOM. In this study, NOM was safe and effective even in high-grade injuries.
过去几十年积累的经验表明，在某些特定情况下，可安全地对平民枪伤性肝损伤采取非手术治疗（NOM）。本研究旨在比较选择性非手术治疗与手术治疗（OM）对肝枪伤（GSW）患者的疗效。
对2008年至2016年期间巴西一家创伤转诊中心进行了基于登记的回顾性队列分析。纳入年龄在16 - 80岁、右侧腹象限遭受平民枪伤且伴有肝损伤的患者。从个体登记处获取基线数据、生命体征、肝损伤分级、相关损伤、损伤严重程度评分、输血需求、肝脏及非肝脏相关并发症、住院时间（LOS）和死亡率。
共有54例患者符合分析条件，其中37例接受非手术治疗，17例接受手术治疗。中位年龄为25岁，均为男性。两组在患者人口统计学、损伤评分、肝损伤分级和相关损伤方面未观察到统计学显著差异。非手术治疗患者往往遭受更高级别的损伤（86.5%对64.7%；P = 0.08），保守治疗失败记录在2例（5.4%）。并发症发生率为48%，组间无统计学显著差异。手术治疗组的输血需求显著更高（58.8%对21.6%；P = 0.012）。中位住院时间为7天。无死亡记录。
血流动力学稳定且无腹膜炎的肝枪伤患者适合非手术治疗。在本研究中，即使是高级别损伤，非手术治疗也是安全有效的。
