Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy

World Journal of Emergency Surgery

Chih Che Lin³  Jiun-Lung Liang⁴  Tsung Cheng Tsai²  Ting-Min Hsieh¹ 

[1]Division of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan

[2]Department of Emergency, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan

[3]Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan

[4]Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung District, Kaohsiung, Taiwan

关键词: Blunt hepatic and splenic injuries;    Blunt splenic injury;    Blunt hepatic injury;    Non-operative management;   

Others  :  1146076
DOI  :  10.1186/1749-7922-9-51

 received in 2014-05-01, accepted in 2014-09-19,  发布年份 2014

【 摘 要 】

Background

There is growing evidence of clinical data recently for successful outcomes of non-operative management (NOM) for blunt hepatic and spleen injuries (BHSI). However, the effectiveness of NOM for high-grade BHSI remains undefined. The aim of the present study was to review our experience with NOM in high-grade BHSI and compare results with the existing related data worldwide.

Methods

In this retrospectively protocol-driven study, 150 patients with grade 3–5 BHSI were enrolled during a 3-year period. Patients were divided into immediate laparotomy (immediate OP) and initial non-operative (initial NOM) groups according to hemodynamic status judged by duty trauma surgeon. Patients who received initial NOM were divided into successful NOM (s-NOM) and failed NOM (f-NOM) subgroups according to conservative treatment failure. We analyzed the clinical characteristics and the outcomes of patients.

Results

Twenty-eight (18.7%) patients underwent immediate operations, and the remaining 122 (81.3%) were initially treated with NOM. Compared with the initial NOM group, the immediate OP group had significantly lower hemoglobin levels, a higher incidence of tube thoracostomy, contrast extravasation and large hemoperitoneum on computed tomography, a higher injury severity score, increased need for transfusions, and longer length of stay (LOS) in the intensive care unit (ICU) and hospitalization. Further analysis of the initial NOM group indicated that NOM had failed in 6 (4.9%) cases. Compared with the s-NOM subgroup, f-NOM patients had significantly lower hemoglobin levels, more hospitalized transfusions, and longer ICU LOS.

Conclusions

NOM of high-grade BHSI in selected patients is a feasible strategy. Notwithstanding, patients with initial low hemoglobin level and a high number of blood transfusions in the ICU are associated with a high risk for NOM failure.

【 授权许可】

   
2014 Hsieh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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