Brasel K J, DeLisle C M, Olson C J, Borgstrom D C
Department of Surgery, St. Paul-Ramsey Medical Center, University of Minnesota, 55101, USA.
Am J Surg. 1997 Dec;174(6):674-7. doi: 10.1016/s0002-9610(97)00209-2.
Options for management of blunt hepatic injury have broadened to include both operative management (OM) and nonoperative management (NOM). We identify trends in evaluation and management of blunt hepatic injury at a level 1 trauma center.
Charts of 106 patients with blunt hepatic injuries from July 1, 1991 to June 30, 1995 were reviewed for method of abdominal evaluation (computed tomography versus DPL), injury severity score, liver injury grade, method of management, length of stay (LOS), transfusion requirements, complications, and outcome.
Nonoperative management steadily increased to 86%. Successful NOM occurred in 96% (48 of 50) and was not related to injury grade. Transfusion requirements were significantly greater in the group with OM versus those with NOM (11.3 versus 2.7). Patients with NOM also had significantly shorter intensive care unit stay and total LOS.
The majority of patients with blunt liver injury can be successfully managed nonoperatively regardless of injury grade. Nonoperative management may allow decreased resource utilization because of shorter hospital stays and decreased transfusion requirements.
钝性肝损伤的治疗选择已扩大到包括手术治疗（OM）和非手术治疗（NOM）。我们确定了一家一级创伤中心钝性肝损伤评估和治疗的趋势。
回顾了1991年7月1日至1995年6月30日期间106例钝性肝损伤患者的病历，以了解腹部评估方法（计算机断层扫描与诊断性腹腔灌洗）、损伤严重程度评分、肝损伤分级、治疗方法、住院时间（LOS）、输血需求、并发症和结局。
非手术治疗稳步增加至86%。96%（50例中的48例）非手术治疗成功，且与损伤分级无关。与非手术治疗组相比，手术治疗组的输血需求显著更高（11.3对2.7）。非手术治疗患者的重症监护病房住院时间和总住院时间也显著更短。
大多数钝性肝损伤患者无论损伤分级如何，均可通过非手术治疗成功治愈。由于住院时间缩短和输血需求减少，非手术治疗可能会减少资源利用。
