Nonoperative Management of Blunt Hepatic Trauma

Original Article

Journal of the Korean Society of Traumatology 2002;15(1):14-21.

Sung Min Choi, M.D., Man Kyu Chae, M.D. Tae Yun Kim, M.D., Sung Yong Kim, M.D., Moo Jun Baek, M.D., Moon Soo Lee, M.D., and Chang Ho Kim, M.D.

Department of Surgery, College of Medicine, Soonchunhyang University, Chunan, Korea

둔상성 간손상의 비수술적 치료의 유용성

최성민·채만규·김태윤·김성용·백무준·이문수·김창호

순천향대학교 의과대학 천안병원 외과학교실

Abstract

Background : Nonoperative treatment of liver injuries resulting from blunt trauma has gained acceptance over the past decades. The utilization of computerd tomography in the evaluation of blunt abdominal trauma provides the opportunity for nonoperative and observational management in selected patients with blunt hepatic trauma. The aim of this study was to evaluate the safety of nonoperative management of blunt hepatic trauma in hemodynamically stable patients. Methods : Ninety patients(90) with traumatic liver injuries who were admitted to the department of surgery, Soonchunhyang University Chunan Hospital, from July 1989 to June 2001, were treated by nonoperative treatments. The records of these patients were reviewed and compared with those of the operated patients (217 cases). Result : The peak incidence was the 3rd decade, and the male-to-female ratio was 2:1. The most frequent injury mechanism was traffic accident. The abdominal CT was the diagnostic modality used most frequently, and it was performed in all cases of nonoperative treatment. Chest injury was the most common associated one. The degree of injury was classified by using the AAST (American Association for the Surgical Trauma). Grade I was the most common type (39 cases, 43.3%). Between the nonoperative group and the operative group, there were significant differences in systolic blood pressure, hemoglobin level, sGPT level, serum Alkaline phosphatase level, the amount of transfusion, and the injury severity score (P<0.05). Postoperative complications were noted in 10 of the 90 (12.2%) nonoperative patients and in 67 patients (30.8%). the postoperative mortality rate was 3.3% (3cases), and all were due to head injury. Conclusion: Nonoperative management of blunt hepatic injuries based on abdominal CT findings is a useful treatment modality in a selected group of hemodynamically stable patients. The key to successful nonoperative management lies in strict adherence to the selection protocol and aggressive monitoring with intensive care.

Key Words: Blunt hepatic trauma; Nonoperative treatment