간 외상 환자에서의 간 절제술

Abstract

Patients with liver injury can be managed by various techniques, including simple closure, electrocautery, hemostatic agent application, temporary packing, perihepatic drainage, and hepatic resection. Two different types of hepatic resections can be employed in selected and advanced hepatic injury; resectional debridement and anatomical hepatic resection. The aim of this study was to consider the role of hepatic resection in the management of severe liver trauma and to define the roles of the different types of resections. METHODS: Two hundred two patients with traumatic liver injury underwent surgical treatment from July 1989 to June 1998 at the Department of Surgery, Soonchunhyang University Chunan Hospital. From them, the records of forty-six patients who received hepatic resections in the same period were collected. Demographic, clinical, operative, and postoperative data were collected and analyzed. RESULTS: Among the patients with resectional management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 3.11. The most frequent injury mechanism was blunt trauma (95.7%). There was one postoperative death among the 8 anatomical resections (12.5%) and nine postoperative deaths among the 38 resectional debridements (24.4%). The overall mortality rate was 21.7%. There were no intraoperative deaths. Postoperative complications occurred in 11 patients (23.9%). CONCLUSIONS: Hepatic resection can play a major role in the management of hepatic trauma. It can be indicated in cases of deep laceration in the liver involving major vascular structures or the bile duct, extensive devitalization of the hepatic parenchyma, and hepatic venous bleeding. In selected cases, an anatomical resection can be successful by making a clear line of resection through anatomical planes away from any damaged parenchyma.