Carrillo E H, Platz A, Miller F B, Richardson J D, Polk H C
Department of Surgery, University of Louisville School of Medicine, Kentucky, USA.
Br J Surg. 1998 Apr;85(4):461-8. doi: 10.1046/j.1365-2168.1998.00721.x.
Non-operative management is currently considered the treatment of choice in over 50 per cent of adult patients with blunt liver injury. This report reviews the criteria for non-operative management and its potential downside.
English language publications were reviewed.
Most reports from major trauma centres in the USA support the non-operative treatment of patients with blunt liver injury if well established criteria are met. Using such criteria, non-operative treatment is successful in 50-80 per cent of cases. Adjunctive radiological techniques may be helpful in managing some complications of non-operative treatment.
Non-operative management is safe in haemodynamically stable patients with blunt liver injury. Computed tomography (CT) of the abdomen is extremely useful to document the extent of the damage and the presence of associated injuries, but it is not possible, based on CT alone, to predict failure; careful physiological monitoring in selected patients is indicated to avoid catastrophic complications.
目前，超过50%的成年钝性肝损伤患者首选非手术治疗。本报告回顾了非手术治疗的标准及其潜在弊端。
查阅英文出版物。
美国各大创伤中心的多数报告支持，若符合既定标准，钝性肝损伤患者可采用非手术治疗。采用这些标准，非手术治疗在50% - 80%的病例中取得成功。辅助放射学技术可能有助于处理非手术治疗的一些并发症。
血流动力学稳定的钝性肝损伤患者采用非手术治疗是安全的。腹部计算机断层扫描（CT）对于记录损伤程度和相关损伤的存在极为有用，但仅基于CT无法预测治疗失败；建议对选定患者进行仔细的生理监测以避免灾难性并发症。
