R R Dalcin, Ytm Petrillo, Lac Alves, M K Fonseca, A S Almeida, C O Corso
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引用次数: 0
Abstract
Introduction: Experience accumulated over the last decades suggests nonoperative management (NOM) of civilian gunshot liver injuries can be safely applied in selected cases. This study aims to compare the outcomes of selective NOM versus operative management (OM) of patients sustaining gunshot wounds (GSW) to the liver.
Methods: A registry-based retrospective cohort analysis was performed for the period of 2008 to 2016 in a Brazilian trauma referral. Patients aged 16-80 years sustaining civilian GSW to right-sided abdominal quadrants and liver injury were included. Baseline data, vital signs, grade of liver injury, associated injuries, injury severity scores, blood transfusion requirements, liver- and non-liver-related complications, length-of-stay (LOS), and mortality were retrieved from individual registries.
Results: A total of 54 patients were eligible for analysis, of which 37 underwent NOM and 17 underwent OM. The median age was 25 years and all were male. No statistically significant differences were observed between groups regarding patients' demographics, injury scores, grade of liver injury and associated lesions. NOM patients tended to sustain higher-grade injuries (86.5% vs 64.7%; p = 0.08), and failure of conservative management was recorded in two (5.4%) cases. The rate of complications was 48% with no between-group statistically significant difference. Blood transfusion requirements were significantly higher in the OM group (58.8% vs 21.6%; p = 0.012). The median LOS was seven days. No deaths were recorded.
Conclusion: Patients with liver GSW who are haemodynamically stable and without peritonitis are candidates for NOM. In this study, NOM was safe and effective even in high-grade injuries.
导言：过去几十年积累的经验表明，对平民枪伤肝脏的非手术治疗（NOM）可安全地应用于特定病例。本研究旨在比较选择性非手术治疗与手术治疗（OM）对肝脏枪伤（GSW）患者的疗效：方法：对巴西一家外伤转诊机构 2008 年至 2016 年期间的病例进行了登记为基础的回顾性队列分析。研究对象包括年龄在16-80岁之间、腹部右侧象限遭受民用GSW并造成肝损伤的患者。从各登记处检索了基线数据、生命体征、肝损伤等级、相关损伤、损伤严重程度评分、输血需求、肝脏和非肝脏相关并发症、住院时间（LOS）和死亡率：共有 54 名患者符合分析条件，其中 37 人接受了 NOM 治疗，17 人接受了 OM 治疗。中位年龄为 25 岁，均为男性。两组患者在人口统计学、损伤评分、肝损伤等级和相关病变方面均无明显差异。NOM患者的损伤等级往往更高（86.5% vs 64.7%; p = 0.08），保守治疗失败的病例有两例（5.4%）。并发症发生率为48%，组间差异无统计学意义。OM组的输血需求明显更高（58.8% vs 21.6%; p = 0.012）。中位住院日为 7 天。无死亡记录：结论：血流动力学稳定且无腹膜炎的肝脏GSW患者适合接受NOM治疗。在这项研究中，NOM对高级别损伤也是安全有效的。
期刊介绍：
The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November.
The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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