Diagnosis and treatment of hepatic trauma: a report of 55 cases / 国际外科学杂志

ABSTRACT

Objective To summarize the experiences of the diagnostic and therapeutiec approach of hepatic trauma.Methods Referencing to the literature of recent years,we retrospectively analyzed the clinieal data of 55 cases of liver trauma.Results Among the 55 cases.18 eases of stage Ⅰ～Ⅱ.1 5 cases of stage Ⅲ,17 eases of stage Ⅳ and 5 cases of stage V,Thirty-one cases received non-operative treatment.and 24 cases reeeived operative therapy.In non-operative treatment group,the cure rate was 100%.In operation Ireatmenl group the cure rate was 91.7%.Conclusions Focused abdominal sonography for trauma (FAST) and diagnostic peritoneal paraeentesis are the initial methods for diagnosis of liver trauma and are largely used nowadays.When the patient is hemodynamically stable,CT scan or simuhaneous contrast-enhanced scan are important to decide for conservative ur surgical treatment.Today.treatment of hepatic lesions takes in account mainly two aspectshemodynamically stability and the mechanism for trauma(blunt or penetrating).Liver injmy score of patienlS is not as important as the hemodynamie status for determining conservative management.Nonoperative management under close continuous observation for the hemodynamically stable patients with stage Ⅰ and Ⅱ and some eases of stage Ⅲ blunt hepatic injury has become the stamlard of care.The decision for surgical intervention should be given in time according to the variance of hemodynamically stability and the presence of trauma (blunt or penetrating).Some cases of stage Ⅲ and all cases of stage Ⅳ to Ⅴ hepatic injury shouht preferably undergo surgieal treatment.The effective preventive measures to decrease mortality in patients with severe hepatic trauma include early remedy to henmrhagie shock.effective hemostasis,complete abdominal drainage and prevention of pnstoperative enmplieations.