Ramos-Jimenez Rafael G, Deeb Andrew-Paul, Truong Evelyn I, Newhouse David, Narayanan Sowmya, Alarcon Louis, Bauza Graciela M, Brown Joshua B, Forsythe Raquel, Leeper Christine, Mohan Deepika, Neal Matthew D, Puyana Juan Carlos, Rosengart Matthew R, Schuchert Vaishali Dixit, Sperry Jason L, Watson Gregory, Zuckerbraun Brian, Marsh J Wallis, Humar Abhinav, Geller David A, Billiar Timothy R, Peitzman Andrew B, Tevar Amit D
Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Trauma Surg Acute Care Open. 2025 Jan 16;10(1):e001611. doi: 10.1136/tsaco-2024-001611. eCollection 2025.
Operative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of operative and nonoperative management (OM and NOM) of HGLI at our institution, characterized by a trauma surgery-liver surgery collaborative approach to trauma care.
This was an observational cohort study of adult patients (age ≥16) with HGLI (The American Association for Surgery of Trauma (AAST) grades IV and V) admitted to an urban level I trauma center from January 2010 to November 2021. Data were obtained from the electronic medical record and state trauma registry. Patients were categorized by management strategy: immediate OM or planned NOM. The primary outcome was 30-day mortality.
Our institution treated 179 patients with HGLI (78% blunt, 22% penetrating); 122 grade IV (68%) and 57 grade V (32%) injuries. All abdominal gunshot wounds and 49% of blunt injuries underwent initial OM; 51% of blunt injuries were managed initially by NOM. Procedures at the initial operation included hepatorrhaphy±packing (66.4%), nonanatomic resection (5.6%), segmentectomy (9.3%), and hepatic lobectomy (7.5%). Thirty-day mortality in the OM group was substantially lower than prior reports (23.4%). Operative mortality attributable to the liver injury was 15.7%. 19.4% of patients failed NOM with one death (1.4%).
We report an operative mortality of 23.4% for HGLI in a trauma care system characterized by a collaborative approach by trauma surgeons and liver surgeons.
III.
高级别肝损伤（HGLI）的手术死亡率仍为42%至66%，肝后腔静脉损伤后的死亡率几乎是100%。本研究的目的是评估在我们机构中，以创伤外科-肝脏外科协作治疗创伤的方法为特征的HGLI手术治疗和非手术治疗（OM和NOM）的死亡率及并发症。
这是一项对2010年1月至2021年11月入住城市一级创伤中心的成年患者（年龄≥16岁）HGLI（美国创伤外科协会（AAST）IV级和V级）的观察性队列研究。数据来自电子病历和州创伤登记处。患者按治疗策略分类：立即手术治疗或计划非手术治疗。主要结局是30天死亡率。
我们机构治疗了179例HGLI患者（78%为钝性伤，22%为穿透伤）；122例IV级损伤（68%）和57例V级损伤（32%）。所有腹部枪伤和49%的钝性伤接受了初始手术治疗；51%的钝性伤最初采用非手术治疗。初次手术的术式包括肝缝合术±填塞（66.4%）、非解剖性切除术（5.6%）、肝段切除术（9.3%）和肝叶切除术（7.5%）。手术治疗组的30天死亡率远低于先前报告（23.4%）。肝损伤导致的手术死亡率为15.7%。19.4%的患者非手术治疗失败，1例死亡（1.4%）。
我们报告了在一个以创伤外科医生和肝脏外科医生协作方法为特征的创伤治疗系统中，HGLI的手术死亡率为23.4%。
III级
