외상성 간 손상환자의 분석

Clinical Analysis on Patients with Traumatic Liver Injury

  • 윤홍만 (서울대학교 의과대학 외과학교실) ;
  • 윤유석 (서울대학교 의과대학 외과학교실) ;
  • 신상현 (서울대학교 의과대학 외과학교실) ;
  • 조재영 (서울대학교 의과대학 외과학교실) ;
  • 박도중 (서울대학교 의과대학 외과학교실) ;
  • 김형호 (서울대학교 의과대학 외과학교실) ;
  • 한호성 (서울대학교 의과대학 외과학교실)
  • Yoon, Hong Man (Department of Surgery, Medical College of Seoul National University) ;
  • Yoon, Yoo Seok (Department of Surgery, Medical College of Seoul National University) ;
  • Shin, Sang Hyun (Department of Surgery, Medical College of Seoul National University) ;
  • Cho, Jai Young (Department of Surgery, Medical College of Seoul National University) ;
  • Park, Do Joong (Department of Surgery, Medical College of Seoul National University) ;
  • Kim, Hyung Ho (Department of Surgery, Medical College of Seoul National University) ;
  • Han, Ho Seong (Department of Surgery, Medical College of Seoul National University)
  • 투고 : 2007.10.31
  • 심사 : 2007.12.16
  • 발행 : 2007.12.30

초록

Purpose: The liver is one of the most commonly injured organs in abdominal trauma. Surgery has played a major role in treating traumatic liver injury. Recently, it was reported that conservative treatment could be the first-line management for hemodynamically stable patients without combined intraabdominal surgical problems. The aim of this study was to examine the prognostic factors in traumatic liver injury. Methods: The medical records of 41 patients who were treated for traumatic liver injury at Seoul National University Bundang Hospital from March 2003 to October 2007 were retrospectively reviewed. Results: Among the 41 patients, 34 cases (82.9%) were managed nonsurgically, and 7 cases (17.1%) were managed surgically. Out of the 5 (12.2%) mortalities, 2 were encountered in those who underwent surgery, and 3 were encountered in those who were treated nonsurgically. Univariate analysis showed that the initial systolic blood pressure, the initial hemoglobin level, and the grade of liver injury were significant prognostic factors for survival. Multivariate analysis indicated that initial low systolic blood pressure was the only independent risk factor. Conclusion: Patients with unstable vital signs initially have a poor prognosis. Aggressive management might be helpful for improving the survival rate in these patients.

키워드

참고문헌

  1. Pringle JH. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 1908;48:541-9 https://doi.org/10.1097/00000658-190810000-00005
  2. Farnell MB, Spencer MP, Thompson E, Williams HJ Jr, Mucha P Jr, Ilstrup DM. Nonoperative management of blunt hepatic trauma. Surgery 1988;104:748-56
  3. Kim JT, Bae KH, Choi SY, Youn SJ, Kim CS. Nonoperative management in blunt hepatic surgery. J Korean Soc Traumatol 1999;12:30-6
  4. Kang SH, Kim YJ, Choi SH. Treatment of Traumatic liver injury. J Korean Soc Traumatol 1997;10:54-60
  5. Pachter HL, Knudson MM, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of Nonoperative Management of Blunt Hepatic Injuries in 1995: A Multicenter Experience with 404 Patients. J Trauma 1996;44:31-8
  6. Lee YJ, Jung GG, Lim BC, Hong SC, Lee JS, Park ST, et al. Clinical Review of Blunt Hepatic Trauma. J Korean Soc Traumatol 2000;13:157-64
  7. Ajai KM, Timothy CF, Martin AC, Timothy JG, Kenneth AK, Gayle M, et al. Blunt hepatic injury: A paradigm shift from operative to nonoperative. Ann Surg 2000; 231:804-13 https://doi.org/10.1097/00000658-200006000-00004
  8. Veroux M, Cillo U, Brolese A, Madia C, Fiamingo P, Zanus G, et al. Blunt liver injury: from non-operative management to liver transplantation. Injury Int J Care Injured 2003;34:181-6 https://doi.org/10.1016/S0020-1383(02)00283-8
  9. Stavros G, Vasilis V, Stylianos G, Nikitas D, Ioannis B, Spyros D, et al. Operative and nonoperative management of blunt hepatic trauma in adults: a single-center. J Hepatobiliary Pancreat Surg 2007;14:387-91 https://doi.org/10.1007/s00534-006-1177-2
  10. Karen JB, Christine MD, Christine JO, David CB. Trends in the management of hepatic injury. Am J Surg 1997;174:674-7 https://doi.org/10.1016/S0002-9610(97)00209-2
  11. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver. J Trauma 1995;38:323-4 https://doi.org/10.1097/00005373-199503000-00001
  12. MIN SK, Han HS, Kim YW, Lee JH, Moon BI, Kim KH, et al. Prognostic factor in traumatic liver injury. J Korean Surg Soc 2002;63:480-5
  13. Choi SM, Chae MK, Kim TY, Kim SY, Baek MJ, Lee MS, et al. Nonoperative management of Blunt hepatic trauma. J Korean Soc Traumatol 2002;15:14-21
  14. Coughlin PA, Stringer MD, Lodge JPA, Pollard SG, Prasad KR, Toogood GJ. Management of blunt liver trauma in a tertiary referral centre. Br J Surg 2004;91:317-321 https://doi.org/10.1002/bjs.4410
  15. Kim SH, Lee KH, Cho JH, Whang SO, Bae KS, Kang SJ Kim SM. Factors Affecting Decision for Treatment Modality of Blunt Liver Injury. J Korean Soc Traumatol 2000;13:82-9
  16. Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. The CT Risk Factors for the Need of Operative Treatment in Initially Hemodynamically Stable Patients After Blunt Hepatic Trauma. J Trauma 2006;61:547-54 https://doi.org/10.1097/01.ta.0000196571.12389.ee
  17. Kim SS, Ko YG, Yoon C, Joo HZ. Traumatic liver Injury sustained for Motor vehicle accident. J Korean Soc Traumatol 1997;10:61-7
  18. Lee CJ, Yu HC, Yang DH. Clinical study on mortality Factors in traumatic liver injury. J Korean Soc Traumatol 1997;10:44-53