Struckmann J R, Pedersen I K, Burcharth F
Kirurgisk gastroenterologisk afdeling D., Amtssygehuset i Herlev
Ugeskr Laeger. 1997 Aug 18;159(34):5098-102.
Over a 15-year period 43 patients were treated for liver trauma in a surgical department, subspecialized in liver surgery. The trauma mechanism was blunt in 88% and penetrating in 12%. According to the Organ Injury Scale system of liver trauma, they consisted of 10 in class I, three in class II, 16 in class III, 11 in class IV and three in class V. Thirty-seven patients were treated operatively while six patients were treated conservatively. The overall mortality rate was 9% and liver related mortality 7%. Other organ lesions were present in 53% of the patients. Patients treated conservatively met initial criteria of which the most important was haemodynamic stability. The most important diagnostic method was CT. If strict criteria are followed, a large proportion of liver trauma patients can be treated nonoperatively, provided there is adequate surveillance facilities including CT, and operative capacity to meet unexpected late bleeding complications.
在15年的时间里,一家专门从事肝脏手术的外科科室对43例肝外伤患者进行了治疗。创伤机制为钝性伤的占88%,穿透性伤的占12%。根据肝外伤器官损伤分级系统,Ⅰ级10例,Ⅱ级3例,Ⅲ级16例,Ⅳ级11例,Ⅴ级3例。37例患者接受了手术治疗,6例患者接受了保守治疗。总死亡率为9%,与肝脏相关的死亡率为7%。53%的患者存在其他器官损伤。接受保守治疗的患者符合初始标准,其中最重要的是血流动力学稳定。最重要的诊断方法是CT。如果遵循严格的标准,只要有包括CT在内的足够监测设施以及应对意外晚期出血并发症的手术能力,大部分肝外伤患者可以接受非手术治疗。