Artículos de revistas
Blunt Hepatic Trauma: Comparison Between Surgical And Nonoperative Treatment [trauma Hepático Contuso: Comparação Entre O Tratamento Cirúrgico E O Não Operatório]
Registro en:
Revista Do Colegio Brasileiro De Cirurgioes. , v. 39, n. 4, p. 307 - 313, 2012.
1006991
10.1590/S0100-69912012000400011
2-s2.0-84865999065
Autor
Zago T.M.
Pereira B.M.
Calderan T.R.A.
Hirano E.S.
Rizoli S.
Fraga G.P.
Institución
Resumen
Objective: The objective of this study is to examine the outcomes of blunt hepatic trauma, and compare surgical and nonsurgical treatment on patients admitted with hemodynamic stability and with no obvious indications of laparotomy. Methods: This is a retrospective study of cases admitted to a university teaching hospital between 2000 and 2010. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients who were to undergo surgical treatment were divided into two groups: (A) all those patients undergoing surgical treatment (55) and (B) those patients with no obvious indication for surgery (13). Results: Patients treated non-operatively had better physiological conditions on admission, had less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality rates than patients operated upon (Group A). Patients operated upon, but with no obvious indications for surgery, had higher rates of complication and mortality than nonoperated patients. Conclusion: A non-operative approach results in lower complications, a lesser need for blood transfusions and a lower mortality rate. 39 4 307 313 Talving, P., Beckman, M., Häggmark, T., Iselius, L., Epidemiology of liver injuries (2003) Scand J Surg., 92 (3), pp. 192-194 London, J.A., Parry, L., Galante, J., Battistella, F., Safety of early mobilization of patients with blunt solid organ injuries (2008) Arch Surg., 143 (10), pp. 972-976. , discussion 977 Smaniotto, B., Bahten, L.C.V., Nogueira Filho, D.C., Tano, A.L., Thomaz Júnior, L., Fayad, O., Trauma hepático: Análisedo tratamento com balão intra-hepático em um hospital universitário de Curitiba (2009) Rev Col Bras Cir., 36 (3), pp. 217-222 Stracieri, L.D., Scarpelini, S., Hepatic injury (2006) Acta Cir Bras., 21 (SUPPL. 1), pp. 85-88 Velmahos, G.C., Toutouzas, K., Radin, R., Chan, L., Rhee, P., Tillou, A., High success with nonoperative management of blunt hepatic trauma: The liver is a sturdy organ (2003) Arch Surg., 138 (5), pp. 475-480. , discussion 480-1 Malhotra, A.K., Fabian, T.C., Croce, M.A., Gavin, T.J., Kudsk, K.A., Minard, G., Blunt hepatic injury: A paradigm shift from operative to nonoperative management in the 1990s (2000) Ann Surg., 231 (6), pp. 804-813 Mullinix, A.J., Foley, W.D., Multidetector computed tomography and blunt thoracoabdominal trauma (2004) J Comput Assist Tomogr., 28 (SUPPL. 1), pp. S20-S27 Jacobs, D.G., Sarafin, J.L., Marx, J.A., Abdominal CT scanning for trauma: How low can we go? (2000) Injury., 31 (5), pp. 337-343 Pachter, H.L., Knudson, M.M., Esrig, B., Ross, S., Hoyt, D., Cogbill, T., Status of nonoperative management of blunt hepatic injuries in 1995: A multicenter experience with 404 patients (1996) J Trauma., 40 (1), pp. 31-38 Stein, D.M., Scalea, T.M., Nonoperative management of spleen and liver injuries (2006) J Intensive Care Med., 21 (5), pp. 296-304 Coimbra, R., Hoyt, D.B., Engelhart, S., Fortlage, D., Nonoperative management reduces the overall mortality of grades 3 and 4 blunt liver injuries (2006) Int Surg., 91 (5), pp. 251-257 Moore, E.E., Cogbill, T.H., Jurkovich, G.J., Shackford, S.R., Malangoni, M.A., Champion, H.R., Organ injury scaling: Spleen and liver (1994 revision) (1995) J Trauma., 38 (3), pp. 323-324 Champion, H.R., Sacco, W.J., Copes, W.S., Gann, D.S., Gennarelli, T.A., Flanagan, M.E., A revision of the Trauma Score (1989) J Trauma., 29 (5), pp. 623-629 Baker, S.P., O'Neill, B., Haddon Jr., W., Long, W.B., The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care (1974) J Trauma., 14 (3), pp. 187-196 Civil, I.D., Schwab, C.W., The Abbreviated Injury Scale, 1985 revision: A condensed chart for clinical use (1988) J Trauma., 28 (1), pp. 87-90 Borlase, B.C., Moore, E.E., Moore, F.A., The abdominal trauma index-a critical reassessment and validation (1990) J Trauma., 30 (11), pp. 1340-1344 Schluter, P.J., Nathens, A., Neal, M.L., Goble, S., Cameron, C.M., Davey, T.M., Trauma and Injury Severity Score (TRISS) coefficients 2009 revision (2010) J Trauma., 68 (4), pp. 761-770 Croce, M.A., Fabian, T.C., Menke, P.G., Waddle-Smith, L., Minard, G., Kudsk, K.A., Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial (1995) Ann Surg., 221 (6), pp. 744-753. , discussion 753-5 von Bahten, L.C., Nicoluzzi, J.E., Olandoski, M., Pantanali C.A.R, Silva, R.F.K.C., Trauma abdominal fechado: Análise dos pacientes vítimas de trauma hepático em um hospital universitário de Curitiba (2005) Rev Col Bras Cir., 32 (6), pp. 316-320 Norrman, G., Tingstedt, B., Ekelund, M., Andersson, R., Non-operative management of blunt liver trauma: Feasible and safe also in centres with a low trauma incidence (2009) HPB., 11 (1), pp. 50-56 Meredith, J.W., Young, J.S., Bowling, J., Roboussin, D., Nonoperative management of blunt hepatic trauma: The exception or the rule? (1994) J Trauma., 36 (4), pp. 529-534. , discussion 534-5 Kozar, R.A., Moore, J.B., Niles, S.E., Holcomb, J.B., Moore, E.E., Cothren, C.C., Complications of nonoperative management of high-grade blunt hepatic injuries (2005) J Trauma., 59 (5), pp. 1066-1071 Bynoe, R.P., Bell, R.M., Miles, W.S., Close, T.P., Ross, M.A., Fine, J.G., Complications of nonoperative management of blunt hepatic injuries (1992) J Trauma., 32 (3), pp. 308-314. , discussion 314-5 Malhotra, A.K., Latifi, R., Fabian, T.C., Ivatury, R.R., Dhage, S., Bee, T.K., Multiplicity of solid organ injury: Influence on management and outcomes after blunt abdominal trauma (2003) J Trauma., 54 (5), pp. 925-929 Sikhondze, W.L., Madiba, T.E., Naidoo, N.M., Muckart, D.J., Predictors of outcome in patients requiring surgery for liver trauma (2007) Injury., 38 (1), pp. 65-70 Feliciano, D.V., Mattox, K.L., Jordan Jr., G.L., Burch, J.M., Bitondo, C.G., Cruse, P.A., Management of 1000 consecutive cases of hepatic trauma (1979-1984) (1986) Ann Surg., 204 (4), pp. 438-445 Kozar, R.A., Moore, F.A., Cothren, C.C., Moore, E.E., Sena, M., Bulger, E.M., Risk factors for hepatic morbidity following nonoperative management: Multicenter study (2006) Arch Surg., 141 (5), pp. 451-458. , discussion 458-9 Scollay, J.M., Beard, D., Smith, R., McKeown, D., Garden, O.J., Parks, R., Eleven years of liver trauma: The Scottish experience (2005) World J Surg., 29 (6), pp. 744-749 Archer, L.P., Rogers, F.B., Shackford, S.R., Selective nonoperative management of liver and spleen injuries in neurologically impaired adult patients (1996) Arch Surg., 131 (3), pp. 309-315 Shapiro, M.B., Nance, M.L., Schiller, H.J., Hoff, W.S., Kauder, D.R., Schwab, C.W., Nonoperative management of solid abdominal organ injuries from blunt trauma: Impact of neurologic impairment (2001) Am Surg., 67 (8), pp. 793-796