Stone H H, Ansley J D
J Pediatr Surg. 1977 Feb;12(1):3-10. doi: 10.1016/0022-3468(77)90289-5.
The charts of 203 consecutive children undergoing emergency laparotomy for management of an acute liver injury were reviewed. Although drainage was all that was required in the majority of cases, massive hemorrhage, usually arising from disrupted hepatic veins, appeared to demand liver resection (as performed in 17 children, with a mortality of 18%) during earlier years of the survey. Control of exsanguinating bleeding from such liver wounds by packing with viable autogenous tissue (pedicled omentum) subsequently eliminated almost entirely the need for resection. Fatalities resulting from either hemorrhagic shock or loss of liver substance then became relatively rare. Additional significant problems were associated organ injuries, postoperative wound and intra-abdominal sepsis, bleeding diatheses, and late instances of hemobilia. The overall mortality was 6%.
回顾了203例因急性肝损伤接受急诊剖腹手术的连续儿童的病历。尽管大多数情况下只需引流，但在调查的早期几年，大量出血（通常源于肝静脉破裂）似乎需要进行肝切除术（17例儿童接受了肝切除术，死亡率为18%）。随后，通过用有活力的自体组织（带蒂大网膜）填塞来控制此类肝伤口的大出血，几乎完全消除了肝切除术的必要性。因失血性休克或肝实质丧失导致的死亡随后变得相对罕见。其他重大问题包括相关器官损伤、术后伤口和腹腔内感染、出血性疾病以及晚期胆道出血病例。总体死亡率为6%。
