Smadja C, Traynor O, Blumgart L H
Br J Surg. 1982 Jul;69(7):361-4. doi: 10.1002/bjs.1800690702.
Seven patients with major liver injury initially assessed and managed elsewhere, and then referred to the Hepatobiliary Unit at Hammersmith Hospital, London, are reported. Six of the 7 patients had been operated upon and 4 had undergone two laparotomies before referral. All were seriously ill as a result of bleeding or liver necrosis and infection. Further laparotomy was carried out for the control bleeding, débridement of dead tissue and drainage of infected material. Hepatic resection was performed in all patients and 3 of the 7 died in the postoperative period. Liver resection is necessary for the control of bleeding and removal of dead tissue in severe shattering injuries. Should temporary packing be instituted in order to obtain control, then early referral for definitive treatment is necessary. Delay is dangerous and extension of necrosis with secondary infection is inevitable.
本文报告了7例主要肝脏损伤患者，他们最初在其他地方接受评估和治疗，随后转诊至伦敦哈默史密斯医院的肝胆科。7例患者中有6例接受过手术，4例在转诊前接受过两次剖腹手术。所有患者均因出血、肝坏死和感染而病情严重。为控制出血、清除坏死组织和引流感染物质，进行了进一步的剖腹手术。所有患者均接受了肝切除术，7例中有3例在术后死亡。对于严重粉碎性损伤，肝切除术对于控制出血和清除坏死组织是必要的。如果为了控制出血而进行临时填塞，那么早期转诊进行确定性治疗是必要的。延迟治疗很危险，坏死扩展并继发感染不可避免。
