Non-operative management of isolated liver trauma

Li, Min; Yu, Wenkui; Wang, Xinbo; Ji, Wu; Li, Jieshou; Li, Ning

doi:10.1016/s1499-3872(14)60049-7

Cited by 36 publications

(29 citation statements)

References 31 publications

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“…The mean age ± SD of embolized patients per study was 31 ± 21.9 (range 12–71). Seven studies recorded the number of patient’s undergoing angiography 15, 16, 19, 20, 23–25 . Over two thirds of patients, 72%, undergoing angiography proceeded to embolization.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 6 studies reported the indications for embolization 15–17, 20, 21, 25 . A contrast blush on CT was the most common indication.…”

Section: Resultsmentioning

confidence: 99%

“…Details regarding deaths among embolized patients were obtained from all but one study, and are summarized in Table 2 20 . There were a total of 31 deaths accounting for a death rate of 9.6% among patients undergoing embolization (range 0–27%).…”

Section: Resultsmentioning

confidence: 99%

“…There was only one reported groin hematoma following embolization 15 . Although complications were reported in the studies by Li et al 20 and Tzeng et al 23 , these complications could not be definitively assigned specifically to patients who underwent angioembolization, and therefore these complications were not included in the calculations.…”

Section: Resultsmentioning

confidence: 99%

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Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

101

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Background The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage, as well as the complications associated with this treatment modality. Methods A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization. Results Four hundred and fifty nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks. Conclusion Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies.

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Section: Resultsmentioning

confidence: 99%

“…A total of 6 studies reported the indications for embolization 15–17, 20, 21, 25 . A contrast blush on CT was the most common indication.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

101

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“…U poređenju sa intraoperativno potvrđenim nalazom povrede jetre, inicijalno urađen UZ je bio negativan kod 17,35% bolesnika, dok je bilo svega 5,33% lažno negativnih nalaza na CT. Iako je CT znatno skuplja dijagnostič-ka procedura, manje dostupna i izlaže bolesnika negativnom dejstvu rendgenskih zraka, nameće se potreba za njegovom primjenom kod politraumatizovanih i hemodinamski nestabilnih bolesnika sa negativnim UZ nalazom. Posebna vrijednost ove metode leži i u mogućnosti preciznije dijagnostike povrede, jer koncept neoperativnog liječenja traume jetre sve više privlači pažnju [15,21,24,27,28]. Zbog prisustva krvi u trbuhu kod povreda jetre, osim modernih dijagnostičkih metoda, peritonealna lavaža može da doprinese brzoj selekciji bolesnika za hitnu laparotomiju.…”

Section: Diskusijaunclassified

Izbor optimalne operativne procedure u liječenju povreda jetre

Krivokuća¹,

Mavija²,

Golić

et al. 2016

Biomedicinska istraž.

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Kratak sadržajUvod. Jetra je najčešće povređivan organ u traumi. Zahvaljujući unapređen-ju strategije liječenja, mortalitet kod povreda jetre je posljednjih decenija u značajnom padu. Cilj rada je da prikaže koliko su povrede jetre kompleksan problem koji zahtijeva multidisciplinarni pristup u dijagnostici i liječenju, a ciljevi hirurškog liječenja su kontrola krvarenja, očuvanje funkcije jetre i prevencija komplikacija.Metode. Retrospektivnom studijom je obuhvaćeno 98 bolesnika operisanih zbog povreda jetre na Klinici za Opštu i abdominalnu hirurgiju UKC Banja Luka u periodu 2006-2016. Iz istorije bolesti su analizirani: epidemiološki podaci, mehanizam nastanka traume, dijagnostički pristup, stepen povrede jetre, ukupna težina traume, učinjene hirurške procedure, ishod liječenja i komplikacije.Rezultati. Od 288 bolesnika koji su operisani zbog teške abdominalne traume, 98 je imalo povredu jetre (33 izolovane povrede jetre, a 55 udružene povrede jetre i nekog od abdominalnih organa). Tretman teških povreda jetre uključivao je perihepatično pakovanje kod 12, suturu jetre kod 71 i neki od tipova resekcije jetre kod 5 bolesnika. Kod 10 bolesnika učinjena je samo hirurška eksploracija i drenaža trbušne duplje. Od 74 bolesnika, kod kojih je uzrok povrede bila tupa trauma, umrlo je 19 (25,68%), dok su od 24 bolesnika sa ubodnom i sklopetarnim povredama umrla dva (8,33%) bolesnika. Mortalitet je bio značajno niži kod pacijenata s povredama I, II i III stepena u odnosu na povrede IV I V stepena (p = 0,015). Četiri (4,08%) bolesnika su imala postoperativnu sepsu, 20 (20,41%) pleuralni izliv, a kod tri (3,06%) bolesnika se razvio akutni respiratorni distress sindrom (ARDS).Zaključak. Ukupni mortalitet od 21,4% u našoj studiji je bio usko povezan sa stepenom težine povrede jetre, a značajno je smanjen zahvaljujući savremenim dijagnostičkim i terapijskim metodama.

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