Clinical efficacies of the conservative and surgical treatment of grade Ⅲ and Ⅳ traumatic hepatic rapture / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical efficacies of the conservative and surgical treatment of grade m and Ⅳ traumatic hepatic rapture.Methods The clinical data of 77 patients with traumatic hepatic rapture were analyzed.All the patients were admitted to the Fuzhou General Hospital of Nanjing Military Command from January 2004 to June 2014.According to the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS) and the Becker classification,there were 44 patients and 33 patients had grade Ⅲ and grade Ⅳ traumatic hepatic rapture,respectively.The vital signs,condition of the wound and the resuhs of imaging examination were comprehensively analyzed,and the conservative and surgical treatment methods were selected accordingly.Patients were followed up via outpatient examination or telephone interview till September 2014.Results There were 19 patients received conservative treatment and 25 received surgical treatment among the 44 patients with grade m traumatic hepatic rapture,and 5 received conservative treatment and 28 received surgical treatment among the 33 patients with type Ⅳ traumatic hepatic rapture.Thirty-one patients received suture of the liver,18 received partial hepatectomy and 4 received damage control surgery.All the 77 patients were cured without perioperative death.For patients with grade m traumatic hepatic rapture,the duration of hospital stay were (12 ± 9)days and (20 ± 15)days for patients received conservative and surgical treatment,respectively; and for patients with grade Ⅳ traumatic hepatic rapture,the duration of hospital stay were (17 ± 3) days and (34 ± 25) days for patients received conservative and surgical treatment,respectively.Nineteen patients had complications,including 10 with hepatic abscess,5 with bile leakage (cured by puncture and drainage),2 with pseudoaneurysm (cured by interventional therapy with digital subtraction angiography),1 with adhesive intestinal obstruction and delayed hemorrhage (cured by operation for 2 times).Seventy-one patients were followed up,with the rate of 92.2％ (71/77).The median time of follow-up was 7 months (range,3-15 months).Only 1 patient was complicated with hepatic abscess at postoperative month 13,and was cured by puncture and drainage,and the other patients were live and well.Conclusions The success rate of operation for patients with grade m traumatic hepatic rapture is relatively high with short hospital stay and quick recovery of patients.The indication of conservative treatment for patients with grade Ⅳ traumatic hepatic rapture should be strictly controlled,and the surgical treatment is the main means of therapy.Hepatic abscess,bile leakage and pseudoaneurysm are the common complications for patients with traumatic hepatic rapture.