Severe hepatic trauma: surgical strategies.
- Author:
Jinmou GAO
1
;
Dingyuan DU
;
Xingji ZHAO
;
Guolong LIU
;
Jun YANG
;
Shanhong ZHAO
;
Xi LIN
Author Information
- Publication Type:Journal Article
- MeSH: Adolescent; Adult; Age Factors; Aged; Female; Hemostasis, Surgical; methods; Hepatectomy; methods; mortality; Humans; Injury Severity Score; Laparotomy; methods; Liver; injuries; surgery; Liver Diseases; etiology; mortality; surgery; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; Sex Factors; Survival Rate; Treatment Outcome
- From: Chinese Journal of Traumatology 2002;5(6):346-351
- CountryChina
- Language:English
-
Abstract:
OBJECTIVETo probe into effective surgical procedures and improve the outcome of treatment for patients with severe hepatic injury.
METHODSA retrospective study involving 113 patients with severe hepatic trauma (AAST grade IV and V) during the past 12 years was carried out. Ninety-eight patients underwent surgical treatment. Surgical interventions including hepatectomy or direct control of bleeding vessels by finger fracture technique with Pringle maneuver, selective ligation of hepatic artery, retrohepatic caval repair with total hepatic vascular occlusion, and perihepatic packing were mainly used.
RESULTSIn the 98 patients treated operatively, the survival rate was 69.4% (68/98). Among 40 patients with juxtahepatic venous injury (JHVI), 15 were cured with the maximum blood transfusion of 12,000 ml. Eight cases of Grade IV injury treated nonoperatively were cured. The percentage of failure of nonoperative management was 42.9% (6/14). The overall mortality rate was 32.7% (37/113), and 57% of the deaths were due to exsanguination.
CONCLUSIONSReasonable surgical procedures based on classification of hepatic injuries can increase the survival rate of severe liver trauma. Accurate perihepatic packing is effective in dealing with JHVI.
