Alho A, Karaharju O, Kallio E
Ann Chir Gynaecol. 1978;67(2):66-9.
Fifty-six cases with blunt hepatic injuries occurred in 255 laparotomies on patients with multiple injuries. Pre-operatively, one-half of the patients were in profound shock. In these cases hepatic bleeding was often accompanied by bleeding in other sites, usually from a ruptured spleen or into a retroperitoneal haematoma. Diagnosis was aided by laparocentesis and peritoneal lavage. In 3 cases the diagnosis was delayed for 8--12 hours. The lacerations were sutured in 43 cases, a local resection was made in 10 cases and a lobar resection in 3 cases. Manual compression of the liver was the best way of achieving temporary haemostasis. In cases where haemodynamic stability was not achieved post-operatively, immediate re-operation to attain haemostasis was definitely advantageous. The mortality from multiple blunt injuries was high (17%) but especially so in cases with hepatic injury (41%). Liver injuries after blunt trauma can often be managed by suturing, and hepatic resection in seldom necessary.
在255例多发伤患者的剖腹手术中，发生了56例钝性肝损伤。术前，半数患者处于重度休克状态。在这些病例中，肝出血常伴有其他部位出血，通常来自破裂的脾脏或进入腹膜后血肿。腹腔穿刺术和腹腔灌洗有助于诊断。3例诊断延迟了8 - 12小时。43例进行了裂伤缝合，10例进行了局部切除，3例进行了肝叶切除。手法压迫肝脏是实现临时止血的最佳方法。术后若未实现血流动力学稳定，立即再次手术以实现止血肯定是有益的。多发钝性伤的死亡率很高（17%），但肝损伤病例尤其高（41%）。钝性创伤后的肝损伤通常可通过缝合处理，很少需要进行肝切除。
