Zantut L F, Machado M A, Volpe P, Poggetti R S, Birolini D
Disciplina de Cirurgia do Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de S. Paulo.
Rev Assoc Med Bras (1992). 1995 Jan-Feb;41(1):53-9.
Injury of the extra-hepatic biliary tract is infrequent, occurring in approximately 3.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury caused by blunt abdominal trauma is rare. PURPOSE--Retrospective analysis of 5069 patients with abdominal trauma treated at the Department of Surgery University of São Paulo School of Medicine over a six-year period from 1986 through 1991. METHODS--Forty five patients with gallbladder and extra-hepatic ducts injury were identified (0.89%) and divided in two groups according to the nature of trauma: 12 caused by non-penetrating injuries and 33 to penetrating injuries. Records, including operative and pathology reports, were reviewed to study the site of injury, associated intra-abdominal injuries, incidence, trauma scores, treatment, morbidity, mortality rates and correlated with the nature of the trauma. RESULTS--Overall mortality was 24.4%. The incidence was greater in patients sustaining penetrating abdominal trauma (p < 0.05). Forty of the 45 patients (88.9%) had liver lacerations, the most commonly seen injuries. The patients with blunt abdominal trauma had significant different trauma scores (p < 0.05) than those with penetrating trauma, indicating greater severity in this group of patients. CONCLUSION--There is a relation between severity of trauma and incidence of extra-hepatic biliary tract injury. However, in the penetrating trauma, the incidence of trauma is correlated with the direction of the wound and there is no relation with the severity of trauma. The greater mortality seen in the patients sustaining non-penetrating injury (p < 0.05) supports this observation.
肝外胆道损伤并不常见，在所有钝性和穿透性腹部创伤患者中发生率约为3.5%。钝性腹部创伤导致这种损伤的发生率很低。目的——回顾性分析1986年至1991年期间在圣保罗大学医学院外科治疗的5069例腹部创伤患者。方法——确定了45例胆囊和肝外胆管损伤患者（0.89%），并根据创伤性质分为两组：12例由非穿透性损伤引起，33例由穿透性损伤引起。回顾包括手术和病理报告在内的记录，以研究损伤部位、相关的腹内损伤、发生率、创伤评分、治疗、发病率、死亡率，并与创伤性质相关联。结果——总体死亡率为24.4%。穿透性腹部创伤患者的发生率更高（p<0.05）。45例患者中有40例（88.9%）有肝裂伤，这是最常见的损伤。钝性腹部创伤患者的创伤评分与穿透性创伤患者有显著差异（p<0.05），表明这组患者病情更严重。结论——创伤严重程度与肝外胆道损伤发生率之间存在关联。然而，在穿透性创伤中，创伤发生率与伤口方向相关，与创伤严重程度无关。非穿透性损伤患者的死亡率更高（p<0.05）支持了这一观察结果。
