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发表于 2019-10-24 23:45 | 显示全部楼层 |阅读模式

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Minerva Chir. 2015 Feb;70(1):7-15. Epub 2014 Jul 3.
Management of grade III-IV blunt liver traumas: a comparative, observational study.
Bonariol L1, Massani M, Caratozzolo E, Ruffolo C, Recordare A, Scarpa M, Stecca T, Cegolon L, Bassi N.
Author ***rmation
1
II Department of Surgery (IV Unit) Regional Hospital \"Ca\' Foncello\", Treviso, Italy - bonariol@libero.it.
Abstract
AIM:
The aim of the present study was to assess the impact of angiographic embolization in view of expanding indications for the conservative management of grade III-IV liver injuries.

METHODS:
Fifty ** patients with grade III-IV hepatic trauma were admitted to our Hepato-Biliary-Pancreatic Surgery and Level II Regional Trauma Center from 1993 to 2010 and retrospectively **yzed. Injury severity, management strategies and outcomes of patients admitted between 1993 and 2005 were **yzed and compared with those admitted between 2005 and 2010. Univariable and multivariable logistic models were fitted to investigate the differences between the two time windows studied, in particular with regard to morbidity, mortality, treatment and outcomes, the use of non-operative management and of angiographic embolization.

RESULTS:
At univariable **ysis the majority of the patients treated after 2005 were more likely to have undergone arterial embolization, and less likely to have incurred morbidity, conversion to surgery, or to be admitted to the Intensive Care Unit after initial treatment (baseline category). At multivariable **ysis the patients treated before 2005 were more likely to be older than 25 years to receive angiographic embolization and less likely to undergo conversion to surgery after failure of non-operative management.

CONCLUSION:
The criteria for the conservative treatment of blunt liver trauma is presently often based on hemodynamic stability in injured patients, but its successful management should, instead, be based also on early CT recognition of arterial bleeding and prompt use of angiographic embolization to control it.

PMID: 24992325

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