Causes analysis and management strategies for postoperative haemorrhage of blunt liver injury

HUANG Chao; ZHANG Kun; JIANG Yi

doi:10.3969/j.issn.1009-4237.2017.04.002

Abstract：Objective To analyse the causes and the management strategies for postoperative haemorrhage of blunt liver injury.Methods Clinical data,especially the situation of peritoneal drainage tube of 63 patients with blunt liver injury after surgery was reviewed retrospectively in the Fuzhou General Hospital of Nanjing Military Command between Sep.2003 and Sep.2016. According to the severity of liver injury and whether postoperative drainage tube discharged pus,they were respectively divided into mild group and severe group,drainage group and no drainage group to compare differences in bleeding rates.In the light of whether postoperative hemorrhage occurred,they were divided into bleeding group and no bleeding group to compare differences in preoperative prothrombintime (PT).Results Twenty-three cases (36.50％)of 63 cases of blunt liver trauma developed various degrees of haemorrhage,including post-hepatectomy in 20 cases,of which 4 cases were grade A,7 cases were grade B,and 9 cases were grade C by the standard of post-hepatectomy haemorrhage(PHH) of the International Study Group of Liver Surgery(ISGLS).The median time of postoperative haemorrhage occurrence was 24 hours,and was 3 hours from diagnosis of postoperative bleeding to reoperation or intervention.Twelve cases were successfully treated by nonoperative treatment,and eleven cases were treated by second operation,of which nine cases were PHH,with peritoneal drainage of numerous bright or dark red blood in postoperative 48h.Three patients died of postoperative hemorrhage,including two patients of second surgery and the mortality rate was 13.04％ (3/23),and reoperation mortality was 18.2％ (2/11).Bleeding rates of severe injury group and the drainage group were significantly higher than those of the mild injury group and no drainage group (P=0.047 and P=0.01).The extension time of PT in patients with postoperative bleeding was significantly longer than those without bleeding (P=0.000),indicating that postoperative bleeding in liver injury patients may be related to occult bleeding,severity of the injury,coagulation dysfunction and wound infection.Conclusion Bleeding was a serious postoperative complication after liver injury,and the mortality was high,mainly for PHH.Postoperative hemorrhage after liver injury was primarily related to vascular occult bleeding,the severity of liver injury,coagulation dysfunction,and wound infection.Early bleeding of postoperative of liver injury preferred nonoperative treatment,and patients with unstable vital signs or persistent declining of hemoglobin required second surgery.Taking corresponding treatment measures according to different bleeding causes can minimize postoperative bleeding mortality.