Surgical treatment for severe liver injuries: a single-center experience
| Autor: | Doina Hrehoret, Vladislav Brasoveanu, Gabriela Droc, Dana Tomescu, Alexandru Barcu, Nausica Picu, Ioana Gabriela Lupescu, Florin Botea, Elena Flutur, Bianca Mitricof, Irinel Popescu |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Abdominal Injuries Liver transplantation Single Center 03 medical and health sciences Young Adult 0302 clinical medicine Injury Severity Score medicine Humans Prospective Studies Prospective cohort study Stab wound Child Aged Retrospective Studies business.industry Mortality rate Decision Trees Middle Aged medicine.disease Surgery Treatment Outcome Abdominal trauma Liver Blunt trauma 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female business |
| Zdroj: | Minerva chirurgica. 75(2) |
| ISSN: | 1827-1626 |
| Popis: | Background The liver is one of the most frequently injured organs in abdominal trauma. The advancements in diagnosis and interventional therapy shifted the management of liver trauma towards a non-operative management (NOM). Nevertheless, in severe liver injuries (LI), surgical treatment often involving liver resection (LR) and rarely liver transplantation (LT) remains the main option. The present paper analyses a single center experience in a referral HPB center on a series of patients with high-grade liver trauma. Methods Forty-five patients with severe LI, that benefitted from NOM (6 pts), LRs (38 pts), and LT (1 pt) performed in our center between June 2000 and June 2019, were included in a combined prospective and retrospective study. The median age of the patients was 29 years (median 33, range 10-76), and the male/female ratio of 33/12. Almost all cases had blunt trauma, except 2 with stab wound (4.4%). Results LIs classified according to the American Association for the Surgery of Trauma (AAST) system were 13.3% (grade III), 44.2% (grade IV), and 42.2% (grade V); none were grade I, II or VI. The rate of major LR was 56.4% (22 LRs). The median operative time was 200 minutes (mean 236; range 150-420). The median blood loss was 750 ml (mean 940; range 500-6500). Overall and major complication rates were 100% (45 pts) and 33.3% (15 pts), respectively. Overall mortality rate was 15.6% (7 pts). Conclusions Severe liver trauma, often involving complex liver resections, should be managed in a referral HPB center, thus obtaining the best results in terms of morbidity and mortality. |
| Databáze: | OpenAIRE |
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