[The current approach to liver injuries].
OBJECTIVE
The authors analyze their own three-year material within the treatment (both surgical and conservative) of the injury of liver.


METHODS
During the given period 18 patients with the injury of liver were treated, of which 15 (83%) surgically and 3 (17%) conservatively. The group included 13 men (72%) and 5 women (28%), the average age at the time of injury was 30 years (range, 19-44 years). Ten patients (56%) suffered a blunt injury and 8 patients (44%) a penetrating injury, of which in 5 patients it was the case of a stab wound and in 3 patients a gunshot wound.


METHODS
Indicated to operation were patients with a continuous intraabdominal bleeding, multiple organ injury of the abdominal cavity, simultaneous injury of diaphragm and gunshot wounds in the abdominal cavity. The method of treatment of the liver was determined by the extent of the injury. The authors accept the selective non-surgical treatment of hemodynamically stabilized patients which was developed on the basis of modern imaging methods. The condition of patients is also limited by the extent and severity of associated injuries. Hepatic injuries were classified according to American Association for the Surgery of Trauma, 1994.


RESULTS
The average amount of hemoperitoneum in the patients operated on amounted to 1 550 ml. (200-4000) of blood, the average number of transfusion units 9 (4-20), the average duration of hospitalization at the intensive care unit was 7 (1-44) days and at the surgical department 10 (1-24) days. The average amount of hemoperitoneum according to Federle classification in the nonoperated on patients was 250 ml (200-375), the average number of transfusion units was 1.2 (1-2) of erythrocyte mass, the average duration of the stay in the intensive care unit of the surgical department was 2.3 (2-3) and at the surgical department 6.9 (6-8) days. Complications were recorded in 5 (28%) patients. During resuscitation 6 patients (33%) died due to hemorrhagic shock and in 2 (11%) patients we introduced during the resuscitation intracaval shunt.


CONCLUSIONS
Non-surgical treatment has become a standard method of the treatment of a blunt hepatic, injury in the adult population and it is used in the extent of 50-82%. Failure of conservative treatment at present leads to a surgical intervention. Surgery is indicated in patients which continuously require transfusions, whose vital indicators have deteriorated and where there are evident growing signs of peritoneal irritation.


CONCLUSIONS
Non-surgical treatment of blunt hepatic injuries should be initial in all patients with a secured hemodynamic stability. As it is impossible to find out in which patients non-surgical treatment will fail, the initial period of observation at the intensive care unit is a guarantee of a selective approach. If all its principles are observed the percentage of success of this treatment should exceed 90%.
Zelenák
J
J
Chirurgické oddelenie NsP Ruzinov, Bratislava.
Hutan
M
M
Kálig
K
K
D000328:Adult; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008297:Male; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery