Journal of Trauma and Injury

  • 제28권4호
  • /
  • Pages.284-291
  • /
  • 2015
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

다발성 손상 환자에서의 복부 손상에 대한 비수술적 치료: 권역 외상 센터가 아닌 3차 병원의 치료 경험(2009~2014)

Nonoperative Treatment for Abdominal Injury in Multiple Trauma Patients: Experience in the Metropolitan Tertiary Hospital in Korea (2009~2014)

  • 오승영 (서울대학교 의과대학 외과학교실) ;
  • 서길준 (서울대학교 의과대학 응급의학교실)
  • Oh, Seung-Young (Department of Surgery, Seoul National University College of Medicine) ;
  • Suh, Gil Joon (Department of Emergency Medicine, Seoul National University College of Medicine)
  • 투고 : 2015.12.03
  • 심사 : 2015.12.11
  • 발행 : 2015.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

The aim of this study is to present a nonoperative treatment for abdominal injuries in patients with multiple traumas and to discuss the role of metropolitan tertiary hospital, non-regional trauma centers. We collected data from patients with multiple traumas including abdominal injuries from 2009 to 2014. Patient characteristics, associated injuries, short-term outcomes and departments that managed the patients overall were analyzed. Based on treatment modalities for abdominal injury, patients were divided into two groups: the operative treatment group and the nonoperative treatment group. We compared differences in patient characteristics, injury mechanisms, initial vital signs, detailed injury types, lengths of hospital and ICU stays. Of the 167 patients with multiple traumas, abdominal injuries were found in 57 patients. The injury mechanism for 44 patients (77.2%) was traffic accidents, and associated extra-abdominal injuries were shown in 45 patients (78.9%). The mean lengths of hospital and ICU stays for the 57 patients were 36.4 days and 8.3 days, respectively. The in-hospital mortality rate was 8.8%. Ten patients (17.5%) were treated operatively, and 47 patients (82.5%) were treated nonoperatively. Among the 47 patients in the nonoperative treatment group, 17 patients received embolization, and 3 patients underwent a percutaneous drainage procedure. Operative treatments were used more in patients with injuries to the pancreas and bowel. No patient required additional surgery or died due to the failure of nonoperative treatment. No differences in the clinical characteristics except for the detailed injury type were observed between the two groups. In appropriately selected patients with multiple traumas including abdominal injuries, nonoperative treatment is a safe and feasible. For rapid and accurate managements of these patients, well-trained trauma surgeons who can manage problems with the various systems in the human body and who can decide whether nonoperative treatment is appropriate or not are required.

키워드

참고문헌

  1. Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg 2005; 200: 648-69. https://doi.org/10.1016/j.jamcollsurg.2004.11.005
  2. Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma 2008; 64: 943-8. https://doi.org/10.1097/TA.0b013e3180342023
  3. Baik JJ, Kim JI, Choi SH, Choi YC, Jun SY, Lee JH, et al. Nonoperative Management of Blunt Liver Trauma. J Korean Soc Traumatol 2005; 18: 11.
  4. Park KB, You DD, Hong TH, Heo JM, Won YS. Comparison between operative versus non-operative management of traumatic liver injury. Korean J Hepatobiliary Pancreat Surg 2015; 19: 103-8. https://doi.org/10.14701/kjhbps.2015.19.3.103
  5. Kim T, Jung K, Kwon J, Kim J, Baek S-j, Song S-y, et al. Experience with the Treatment of Patients with Major Trauma at the Department of Trauma Surgery in One Regional Emergency Medical Center for One Year. J Korean Soc Traumatol 2011; 24: 8.
  6. Yoon Y-C, Lee J-N, Chung M, Jeon YB, Park JJ, Yu BC, et al. Three-year Analysis of Patients and Treatment Experiences in the Regional Trauma Center of Gachon University Gil Hospital between 2011 and 2013. J Trauma Inj 2014; 27: 8.
  7. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000; 231: 804-13. https://doi.org/10.1097/00000658-200006000-00004
  8. Hagiwara A, Murata A, Matsuda T, Matsuda H, Shimazaki S. The efficacy and limitations of transarterial embolization for severe hepatic injury. J Trauma 2002; 52: 1091-6. https://doi.org/10.1097/00005373-200206000-00011
  9. Gaarder C, Naess PA, Eken T, Skaga NO, Pillgram-Larsen J, Klow NE, et al. Liver injuries--improved results with a formal protocol including angiography. Injury 2007; 38: 1075-83. https://doi.org/10.1016/j.injury.2007.02.001
  10. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 2006; 244: 620-8.
  11. Berg RJ, Inaba K, Okoye O, Pasley J, Teixeira PG, Esparza M, et al. The contemporary management of penetrating splenic injury. Injury 2014; 45: 1394-400. https://doi.org/10.1016/j.injury.2014.04.025
  12. Leenen LP. Abdominal trauma: from operative to nonoperative management. Injury 2009; 40 Suppl 4: S62-8.
  13. Holmes JHt, Wiebe DJ, Tataria M, Mattix KD, Mooney DP, Scaife ER, et al. The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. J Trauma 2005; 59: 1309-13. https://doi.org/10.1097/01.ta.0000197366.38404.79
  14. Giannopoulos GA, Katsoulis IE, Tzanakis NE, Patsaouras PA, Digalakis MK. Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital? Scand J Trauma Resusc Emerg Med 2009; 17: 22. https://doi.org/10.1186/1757-7241-17-22
  15. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006; 354: 366-78. https://doi.org/10.1056/NEJMsa052049