Management of Liver Trauma
Management of Liver Trauma
复制标题
DOI：
10.1007/s00268-009-0215-z
复制
发表时间：
2009-12-01
影响因子：
2.6
通讯作者：
Diamond, T.
中科院分区：
文献类型：
--
作者：
Badger, S. A.;Barclay, R.;Diamond, T.
背景 钝性和穿透性肝脏创伤很常见，常常会带来重大的诊断和治疗问题。方法进行文献回顾以确定当前调查和治疗策略的共识。结果肝脏是腹部创伤后最常受伤的器官。超声立即评估已取代复苏室中的诊断性腹膜灌洗，但计算机断层扫描仍然是金标准检查。病情稳定的患者首选非手术治疗，但病情不稳定的患者则需要进行剖腹手术。建议采用损伤控制技术，如肝周填塞、肝切开术加直接缝合和切除清创术。现在认为，诸如解剖切除或房腔分流之类的主要复杂外科手术在紧急情况下是多余的。还建议经验不足的外科医生进行打包，以便在转移到三级中心之前进行控制和稳定。介入放射技术的应用越来越广泛，特别是对于接受非手术治疗或通过肝周填塞稳定病情的患者。 结论 在过去二十年中，肝损伤的治疗取得了显着进展。在没有其他腹部损伤的情况下，通常可以避免手术治疗。患有更复杂损伤或后续并发症的患者应转移到专科中心以优化最终结果。
Background Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems.Methods A literature review was undertaken to determine the current consensus on investigation and management strategies.Results The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing.Conclusions Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.