Evolution in the treatment of complex blunt liver injuries.
Evolution in the treatment of complex blunt liver injuries.
复制标题
复杂钝性肝损伤治疗的进展。
DOI：
10.1067/msg.2001.110096
复制
发表时间：
2001
影响因子：
4.4
通讯作者：
H. Polk
中科院分区：
文献类型：
--
作者：
E. Carrillo;C. Wohltmann;J. Richardson;H. Polk
在过去的十年中，钝性肝损伤患者的治疗发生了重大变化，特别是对更复杂损伤采用非手术治疗。这些重大变化可总结如下：
1. 钝性肝损伤患者由外科医生通过超声检查迅速进行筛查。根据初步检查结果和对复苏的反应，就进一步评估做出进一步决策。
2. 计算机断层扫描是钝性创伤后肝脏损伤诊断的主要手段；最初的CT检查结果将有助于创伤外科医生确定非手术治疗方案。
3. I - III级肝损伤可在有监护的病房安全观察，不一定在重症监护病房（ICU）。IV级和V级损伤患者最初最好在ICU观察。
4. 超过三分之二的IV级和V级损伤患者可采用非手术治疗。然而，这些患者中有50%将需要某种介入治疗，但不一定需要剖腹手术。
5. CT扫描的初步结果有助于识别那些需要某种介入治疗的患者以及识别相关损伤。
6. 如果遵循严格的指南，老年患者或伴有相关内科合并症的患者也可采用非手术治疗。
7. 复杂钝性肝损伤患者出现并发症并不罕见。然而，大多数并发症可通过创伤较小的手术安全治疗。
Over the last decade, major changes in the treatment of patients with blunt liver injuries have occurred, specifically with the nonoperative treatment of more complex injuries. These major changes can be summarized as follows: 1. Patients with blunt liver injuries are screened expeditiously by surgeon-performed ultrasonography. Depending on the initial findings and response to resuscitation, further decisions are made regarding the further evaluation. 2. Computed tomographic scanning is the mainstay of diagnosis for hepatic injuries after blunt trauma; the initial CT findings will help the trauma surgeon to determine the nonoperative treatment. 3. Liver injuries of grades I through III can be observed safely in a monitored unit and not necessarily in an ICU setting. Patients with injuries of grades IV and V are best initially observed in an ICU. 4. More than two thirds of patients with injuries of grades IV and V can be treated nonoperatively. However, 50% of these patients will require some type of interventional treatment, but not necessarily a laparotomy. 5. Initial findings on the CT scan can help to identify those patients who will need some type of interventional treatment and to identify associated injuries. 6. Elderly patients or patients with associated medical comorbidities can also be treated nonoperatively if strict guidelines are followed. 7. Complications in patients with complex blunt liver injuries are not uncommon. However, most of the complications can be safely treated by less invasive procedures.