Journal of Trauma and Injury

  • 제18권2호
  • /
  • Pages.161-171
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  • 2005
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

둔상성 간 손상환자의 비수술적 치료

Nonoperative Management of Blunt Liver Trauma

  • 백정주 (성균관대학교 의과대학 마산삼성병원 외과학교실) ;
  • 김정일 (성균관대학교 의과대학 마산삼성병원 외과학교실) ;
  • 최승호 (성균관대학교 의과대학 마산삼성병원 외과학교실) ;
  • 최영철 (성균관대학교 의과대학 마산삼성병원 외과학교실) ;
  • 전시열 (성균관대학교 의과대학 마산삼성병원 외과학교실) ;
  • 이준호 (성균관대학교 의과대학 마산삼성병원 응급의학과교실) ;
  • 황성연 (성균관대학교 의과대학 마산삼성병원 응급의학과교실)
  • Baik, Jung Ju (Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Jung Il (Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Choi, Seung Ho (Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Choi, Young Cheol (Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jun, Si Youl (Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Jun Ho (Department of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hwang, Seong Youn (Department of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2005.09.12
  • 심사 : 2005.11.11
  • 발행 : 2005.12.30
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초록

Background: The management of hepatic injuries has changed dramatically during the past two decade after the technologic breakthroughs in radiologic imaging techniques. Recently, the non-operative management of blunt hepatic trauma has become the standard of care in hemodynamically stable patients. We reviewed our experience of the non-operative management of blunt hepatic trauma. And the purpose of this study was to examine the prognostic factors and indicators affecting the decision for treatment modality of emergent hepatic trauma. Methods: The medical records of 84 patients who were treated for blunt hepatic injury at Masan Samsung Hospital from January 2002 to December 2003. The patients were divided two groups, non-operative(Non-OP) and operative(OP), according to the treatment modality. The two groups were compares for age, sex, mechanism of injury, grade of liver injury scale, combined injury, systolic blood pressure, pulse rate, hemoglobin, hematocrit, WBC count, S-GOT, S-GPT, ALP, transfusion amount during initial 24 hours, amount of infused crystalloid fluid, length of ICU stay, length of ward care, morbidity and mortality. The grade of the liver injury were determined by using the organ injury scale(OSI). Results: Among the 84 patients, 46 cases(54.8%) were managed non-surgically, and 3 cases of Non-OP group were treated by transarterial embolization. Between the two groups, there were significant difference in age, injury grade, combined injury, hemoglobin, hematocrit, initial systolic blood pressure, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, and length of ICU care, morbidity and mortality.(p<0.05) The overall mortality rate was 8.3%, but 2.2% mortality in the non-operative group. Conclusion: Non-operative management may be considered as a first choice in hemodynamic stable patients with blunt liver trauma. The reliable indicators affecting the treatment modality of blunt hepatic trauma were systolic BP, Hb, Hct, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, liver injury grade and combined injury. Strict selection of treatment madality and aggresive monitoring with intensive care unit were more important.

키워드

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