Severe hepatic trauma: surgical strategies.
OBJECTIVE
To probe into effective surgical procedures and improve the outcome of treatment for patients with severe hepatic injury.


METHODS
A 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.


RESULTS
In 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.


CONCLUSIONS
Reasonable 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.
Gao
Jinmou
J
Department of Traumatology, Chongqing Emergency Medical Center, Chongqing 400014, China. cemc@public.cts.cy.cn
Du
Dingyuan
D
Zhao
Xingji
X
Liu
Guolong
G
Yang
Jun
J
Zhao
Shanhong
S
Lin
Xi
X
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008099:Liver / Q000293:injuries* / Q000601:surgery*; D008107:Liver Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome