Abstract: Objective:To investigate the diagnosis and treatment of traumatic hepatorrhexis.
Methods:The clinical data of 183 patients with traumatic hepatorrhexis who were admitted to the Nanshan Hospital from January 2004 to December 2013 were retrospectively analyzed. The size, range and degree of the hepatorrhexis and involvement of other organs were investigated by B ultrasound, computed tomography and abdominal puncture. All patients were classified by the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST OIS). Conservative treatment or surgical procedure was determined according to the clinical symptoms and results of various examinations. Patients were followed up by outpatient examination and telephone interview till April 2014.
Results:One hundred and seventy six patients had epigastria pain or hepatalgia, and 98 patients had hypotension and shock. A total of 142 patients were drawn non coagulative blood by abdominal puncture. One hundred and thirty two patients were detected as with hepatorrhexis by CT and 88 patients with hepatorrhexis by urgent ultrasound. Of the 183 patients classified by AAST OIS, there were 28 patients with grade Ⅰ, 63 with grade Ⅱ, 45 with grade Ⅲ, 30 with grade Ⅳ and 17 with grade Ⅴ. Of the 58 patients received successful conservative treatment, there were 21 patients with grade Ⅰ, 17 with grade Ⅱ, 14 with grade Ⅲ, 5 with grade Ⅳ and 1 with grade Ⅴ. A total of 125 patients were cured by surgery, including 7 patients with grade Ⅰ, 46 with grade Ⅱ, 31 with grade Ⅲ, 25 with grade Ⅳ and 16 with grade Ⅴ. Forty six patients received 〖HJ*6〗peritoneal drainage or simple suture of the liver; 35 with hepatorrhexis received liver suture combined with omentum or absorbent stanching plugging; 13 received irregular hepatectomy; 12 received hepatic artery ligation and ruptured vein suture combined with debridement and hepatectomy, 9 received regular hepatic lobectomy or hepatic segmentectomy, 8 received gauzes packing and 2 died of serious hemorrhagic shock due to hepatic vein and inferior vena injury. The volume of intraoperative blood transfusion was (400±116)mL. The duration of postoperative hospital stay was (12±3)days. Eight patients died at postoperative period. Of the patients who were treated by consenvative treatment, 1 patient with bile leakage and 1 with hepatic haematomas were cured by symptomatic treatment in the conservative treatment group. Of the patients who were treated by conservative treatment, 18 patients with bile leakage and 6 patients with postoperative hemorrhage were cured by symptomatic treatment in the surgery procedure group. One hundred and fifty seven patients were followed up for 4 to 30 months with a mean time of 23 months, and the follow up rate was 85.79%(157/183). The patients were survived normally without complication.
Conclusion:The B ultrasound, computed tomography and abdominal puncture are effective methods for the patients with traumatic hepatorrhexis combined with epigastric pain, hepatalgia and shock. These are key factors for the patients with traumatic hepatorrhexis, determining early AAST OIS grading evaluation, including Ⅰ and Ⅱ grade of AAST OIS are administered by conservative treatment as the main method, Ⅲ to Ⅳ grade of AAST OIS are administered by surgical procedure as the main method, keeping to injury control principles and deciding appropriate treatment methods.