title: [Changes in the diagnosis and therapeutic management of hepatic trauma. A retrospective study comparing 2 series of cases in different (1997-1984 vs. 2001-2008)].
abstract: BACKGROUND
  We present a series of 146 cases of hepatic trauma (HT) treated in our hospital over a period of 8 yearsm (2001-2008), and comparing it with a previous series of 92 cases (1977-1984).
  
  
  METHODS
  The mean age in the current series was 28.6 years and the majority were male. The closed traumas were mainly penetrating, with the most frequent cause being road traffic accidents.
  
  
  RESULTS
  The American Association for the Surgery of Trauma (AAST) classification was used to evaluate the grade of the hepatic injury. Associated abdominal and /or extra-abdominal injuries were seen in 79.5% of the patients, with the most frequent being chest trauma, compared to bone fractures in the previous series. The most common associated intra-abdominal injury was the spleen in both series. The most used diagnostic technique in the current series was abdominal CT. Simple peritoneal puncture and lavage (PLP) were the most used examinations used in the previous series. Non-surgical treatment (NST) was given in 98 cases and the surgery was indicated in the remaining 48. In the previous series, 97.8% of patients were operated on. In the current series, on the 15 patients with severe liver injuries, 5 right hepatectomies, 2 segmentectomies and 6 packing compressions were performed, with the remaining two dying during surgery due to hepatic avulsion. The overall mortality was 3.4%, being 1% in the NST group and 8.3% in the surgical patients. In the previous series, the overall mortality was 29.3%.
  
  
  CONCLUSIONS
  The key factor for using NST is to control haemodynamic stability, leaving surgical treatment for haemodynamically unstable patients.
authors: Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en red de Enfermedades Hepaticas y Digestivas (CIBERehd).
authors: Francisco
authors: F
authors: Sánchez-Bueno
authors: Jezabel
authors: J
authors: Fernández-Carrión
authors: Gloria
authors: G
authors: Torres Salmerón
authors: Rocío
authors: R
authors: García Pérez
authors: Pablo
authors: P
authors: Ramírez Romero
authors: Matilde
authors: M
authors: Fuster Quiñonero
authors: Pascual
authors: P
authors: Parrilla
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries*; D008297:Male; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy*; D014951:Wounds, Stab / Q000175:diagnosis* / Q000628:therapy*