Ulus Travma Acil Cerrahi Derg. 2007; 13(3): 222-226 | |||
Non-operative management of blunt hepatic traumaA. Ziya Anadol, Koray Topgül, Bülent Güngör, Mehmet Bilgin, Mete KesimDepartment Of General Surgery, Ondokuz Mayıs University, Samsun, TurkeyBACKGROUND Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. METHODS Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma’s Organ Injury Scaling System. RESULTS Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. CONCLUSION For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management. Keywords: Blunt hepatic trauma/non-operative, nonpenetrating/ radiography/ultrasonography; tomography, X-ray computed; wounds.Künt karaciğer travmalarına konservatif yaklaşımA. Ziya Anadol, Koray Topgül, Bülent Güngör, Mehmet Bilgin, Mete KesimOndokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, SamsunAMAÇ Cerrahi tedavinin morbidite ve mortalitesinin yüksek olabildiği künt karaciğer travma olgularında, ameliyat edilmeksizin izlenen iyi seçilmiş hastalarda yüksek sağkalım oranları bildirilmektedir. Bu yazıda, invazif tanı ve/veya tedavi yöntemleri uygulanmadan izlenen 19 olgunun sonuçları değerlendirildi. GEREÇ VE YÖNTEM Yatırılarak izlenen ve invaziv tanı yöntemleri ya da cerrahi tedavi uygulanmayan 19 künt karaciğer travmalı hasta (9 erkek, 10 kadın; ort. yaş 46,6; dağılım 19-73) değerlendirildi. Hastaların demografik özelliklerinin yanında, yaşamsal bulguları, hemodinamik parametreleri, karaciğer işlev testleri, transfüzyon gereksinimleri, hastanede kalış süreleri ve izlem amaçlı yapılan radyolojik testler kaydedildi. Karaciğerdeki yaralanmanın sınıflanmasında, Amerikan Travma Cerrahları Birliği’nin Organ Yaralanması Skorlama Sistemi kullanıldı. A. Ziya Anadol, Koray Topgül, Bülent Güngör, Mehmet Bilgin, Mete Kesim. Non-operative management of blunt hepatic trauma. Ulus Travma Acil Cerrahi Derg. 2007; 13(3): 222-226 Corresponding Author: A. Ziya Anadol, Türkiye |
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