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Abstract：
BACKGROUND: According to the National Trauma Data Bank, the liver, after the spleen, is the first most injured organ in closed abdominal trauma.
METHODS: From June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first - line strategy for damage control surgery (DCS) in liver trauma.
RESULTS: 26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure.In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%).
CONCLUSIONS: The improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.
METHODS: From June 2010 to December 2015 we observed in our department of Hepato-biliary Surgery and Liver Transplant Unit of the A.O.R.N. A. Cardarelli of Naples 40 patients affected by hepatic trauma. In our retrospective study, we review our experience and propose portal vein ligation (PVL) as a first - line strategy for damage control surgery (DCS) in liver trauma.
RESULTS: 26/40 patients (65%) which received gauze-packing represented our study group. In 10 cases out of 26 patients (38,4%) the abdominal packing was enough to control the damage. In 7 cases (18,4%) we performed a liver resection. In 7 cases, after de-packing, we adopted PVL to achieve DCS. Trans Arterial Embolization was chosen in 6 patients. 2 of them were discharged 14 days later without performing any other procedure.In 3 cases we had to perform a right epatectomy in second instance. Two hepatectomies were due to hemoperitoneum, and the other for coleperitoneum. Two patients were treated in first instance by only doing hemostasis on the bleeding site. We observed 6 patients in first instance. Five of them underwent surgery with hepatic resection and surgical hemostasis of the bleeding site. The other one underwent to conservative management. In summary we performed 15 hepatic resections, 8 of them were right hepatectomies, 1 left hepatectomy, 2 trisegmentectomies V-VI-VII. So in second instance we operated on 10 patients out of 34 (30%).
CONCLUSIONS: The improved knowledge of clinical physio-pathology and the improvement of diagnostic and instrumental techniques had a great impact on the prognosis of liver trauma. We think that a rigid diagnostic protocol should be applied as this allows timely pathological finding, and consists of three successive but perfectly integrated steps: 1) patient reception, in close collaboration with the resuscitator; 2) accurate but quick diagnostic framing 3) therapeutic decisional making. Selective portal vein ligation is a well-tolerated and safe manoeuvre, which could be effective, even if not definitive, in treating these subjects. That is why we believe that it can be a choice to keep in mind especially in post-depacking bleeding.
摘要：
背景：根据国家创伤数据库，肝脏,脾之后,是腹部闭合性创伤中第一个受伤最严重的器官。
方法：从2010年6月至2015年12月，我们在A.O.R.N.的肝胆外科和肝移植部门进行了观察。A.那不勒斯的Cardarelli40例受肝创伤影响的患者。在我们的回顾性研究中,我们回顾了我们的经验，并建议将门静脉结扎（PVL）作为肝外伤损伤控制手术（DCS）的一线策略。
结果：26/40接受纱布填塞的患者（65%）代表我们的研究组。26例患者中有10例（38,4％）腹部填塞足以控制损伤。在7例（18,4％）中，我们进行了肝切除术。在7个案例中，解封后,我们采用PVL实现DCS。选择经动脉栓塞治疗6例。其中2人在14天后出院，没有进行任何其他程序。在3例病例中，我们必须在第二次病例中进行正确的外延切除术。两次肝切除术是由于腹膜积血,另一个是腹膜。首先通过仅在出血部位进行止血来治疗两名患者。我们首先观察了6例患者。其中五人接受了肝切除手术和出血部位的手术止血。另一个人接受了保守的管理。总之，我们进行了15次肝切除术，其中8个是右肝切除术，左肝切除1次,2三段切除术V-VI-VII。因此，在第二种情况下，我们对34名患者中的10名进行了手术（30％）。
结论：临床病理知识的提高以及诊断和仪器技术的改进对肝外伤的预后有很大影响。我们认为应该应用严格的诊断方案，因为这可以及时进行病理发现，由三个连续但完美整合的步骤组成：1)病人接待，与复苏者密切合作；2）准确但快速的诊断框架3）治疗决策。选择性门静脉结扎是一种耐受性良好且安全的方法，这可能是有效的，即使不是确定的，治疗这些科目。这就是为什么我们认为这可能是一个选择，尤其是在脱袋出血时。
方法：从2010年6月至2015年12月，我们在A.O.R.N.的肝胆外科和肝移植部门进行了观察。A.那不勒斯的Cardarelli40例受肝创伤影响的患者。在我们的回顾性研究中,我们回顾了我们的经验，并建议将门静脉结扎（PVL）作为肝外伤损伤控制手术（DCS）的一线策略。
结果：26/40接受纱布填塞的患者（65%）代表我们的研究组。26例患者中有10例（38,4％）腹部填塞足以控制损伤。在7例（18,4％）中，我们进行了肝切除术。在7个案例中，解封后,我们采用PVL实现DCS。选择经动脉栓塞治疗6例。其中2人在14天后出院，没有进行任何其他程序。在3例病例中，我们必须在第二次病例中进行正确的外延切除术。两次肝切除术是由于腹膜积血,另一个是腹膜。首先通过仅在出血部位进行止血来治疗两名患者。我们首先观察了6例患者。其中五人接受了肝切除手术和出血部位的手术止血。另一个人接受了保守的管理。总之，我们进行了15次肝切除术，其中8个是右肝切除术，左肝切除1次,2三段切除术V-VI-VII。因此，在第二种情况下，我们对34名患者中的10名进行了手术（30％）。
结论：临床病理知识的提高以及诊断和仪器技术的改进对肝外伤的预后有很大影响。我们认为应该应用严格的诊断方案，因为这可以及时进行病理发现，由三个连续但完美整合的步骤组成：1)病人接待，与复苏者密切合作；2）准确但快速的诊断框架3）治疗决策。选择性门静脉结扎是一种耐受性良好且安全的方法，这可能是有效的，即使不是确定的，治疗这些科目。这就是为什么我们认为这可能是一个选择，尤其是在脱袋出血时。
