Surgical therapy for hepatic trauma:experience of 185 cases

LIU Chao-pu; GAO Jin-mou; HU Ping; LI Chang-hua; HE Ping

doi:10.3969/j.issn.1009-4237.2017.04.003

Abstract：Objective To discuss and improve the result of surgical therapy for patients with hepatic injury.Methods Retrospective analysis was made on the result of surgical treatment of 185 patients with hepatic trauma during Jan.2006 and Dec.2015. There were 149 males and 36 females;their age ranged from 15-19 years,with an average of 37 years.According to the American Association for the Surgery of Trauma (AAST),19 patients were grade I,31 were gradeⅡ,59 were grade Ⅲ,48 were grade Ⅳ and 28 were grade Ⅴ(including 17 patients with post-hepatic vena injury).The average score of AIS for hepatic trauma was (3.19±1.19).The average score of ISS for patients with multiple trauma was (18.76±6.64).Hepatic injury was mostly managed by hepatic repair,epiploon tamponade,Pringle's maneuver before blood control,debridement hepatectomy,perihepatic packing and selective hepatic artery ligation.Results Among the 185 patients,163 were cured and 22 died,the overall mortality rate was 11.89％(22 of 185 patients).Nine out of 17 patients with post-hepatic vena injury were cured.Besides associated injuries inside and outside the abdomen,exsanguination or associated coagulopathy was the main cause of death.Conclusion The reasonable surgical procedures should be based on classification of liver trauma.Accurate perihepatic packing with appropriate adjunctive procedures is effective in the treatment of post-hepatic vena injury.