Kasai T, Kobayashi K
Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo, Japan.
Surg Gynecol Obstet. 1993 Dec;177(6):551-5.
In the United States, there has been a trend away from hepatic resection in favor of nonresectional techniques for patients with severe hepatic injury. However, we consider that hepatic resection is more effective and safer, provided that it is performed appropriately. In 1985, we adopted a new protocol for patients undergoing hepatectomy for severe hepatic injury (class IV and V by Moore's classification). This protocol consists of criteria for hepatectomy and application of adjunctive procedures. Since 1985, we have treated 130 patients with hepatic injuries, including 24 patients (20 who underwent hepatectomy) with class IV hepatic injury and 13 patients (ten who underwent hepatectomy) with class V injury. The mortality rates of the patients with hepatic injury with class IV and V injury were 21 and 46 percent, respectively. The mortality rates for patients who underwent hepatectomy, including formal lobectomy to treat class IV and V injury, were 5 and 33 percent, respectively. The mortality rates of the patients with hepatic injury with class IV injury and the hepatectomy patients in both groups were significantly improved after introduction of the protocol. In addition, the outcome was superior to those reported by several trauma centers in the United States. Thus, we conclude that hepatectomy, including formal lobectomy, should be considered as one of the preferred treatment modalities for severe hepatic injury.
在美国，对于严重肝损伤患者，存在一种从肝切除转向非切除技术的趋势。然而，我们认为，只要操作得当，肝切除更有效且更安全。1985年，我们为因严重肝损伤（根据摩尔分类法为IV级和V级）接受肝切除术的患者采用了一种新方案。该方案包括肝切除标准和辅助程序的应用。自1985年以来，我们共治疗了130例肝损伤患者，其中包括24例IV级肝损伤患者（20例行肝切除术）和13例V级损伤患者（10例行肝切除术）。IV级和V级肝损伤患者的死亡率分别为21%和46%。接受肝切除术的患者，包括为治疗IV级和V级损伤而行的正规肝叶切除术，死亡率分别为5%和33%。引入该方案后，两组中IV级肝损伤患者及肝切除患者的死亡率均显著改善。此外，结果优于美国几个创伤中心报告的结果。因此，我们得出结论，包括正规肝叶切除术在内的肝切除术应被视为严重肝损伤的首选治疗方式之一。
