Olsen W R
Surgery. 1982 Oct;92(4):733-43.
Twenty-one patients developed complications of central liver injuries requiring reoperation 1 week to several years after the initial injury. Seven patients were from a series of 320 acute liver injuries treated by us, and 14 were referred to us when their complications became evident. Eleven patients had hepatic abscesses, six had sterile hematomas, and four had hemobilia and its sequelae. Seven patients had asymptomatic vascular disruptions detected with angiography. Two patients developed biliary calculi secondary to hemobilia. Treatment was individualized and ranged from hepatostomy to extended hepatic resection. There were four deaths, three of which were related to the liver injury. Iatrogenic factors were responsible for 62% of these complications. The creation of a central hepatic cavity by superficial suturing or by packing was the most frequent cause, but inadequate resection, failure to provide posterior drainage, and hepatic artery ligation were implicated as well. Late complications of central liver injuries should be infrequent, often are preventable, are not subtle, and respond well to established modes of therapy.
21例患者在初次肝损伤后1周乃至数年出现中央型肝损伤并发症，需要再次手术。7例患者来自我们治疗的320例急性肝损伤病例系列，另外14例患者在并发症明显时转诊至我院。11例患者发生肝脓肿，6例有无菌性血肿，4例有胆道出血及其后遗症。7例患者经血管造影发现无症状的血管破裂。2例患者继发于胆道出血出现胆结石。治疗采取个体化，范围从肝造口术到扩大肝切除术。有4例死亡，其中3例与肝损伤有关。医源性因素导致了这些并发症的62%。通过浅表缝合或填塞形成中央肝腔是最常见的原因，但切除不充分、未进行后引流以及肝动脉结扎也与之有关。中央型肝损伤的晚期并发症应较为少见，通常可预防，并不隐匿，且对既定治疗方式反应良好。
