Đánh giá kết quả điều trị bảo tồn vỡ gan do chấn thương bụng kín tại Bệnh viện Trung ương Quân đội 108

Abstract

Objective: To assess the result of non-operative management of blunt liver trauma at 108 Military Central Hospital from 7/2015 to 7/2019. Subject and method: 67 patients diagnosed with blunt liver trauma were managed non-operatively. The study was conducted descriptively, retrospectively and prospectively without a control group. Result: The mean age was 32.9 ± 13.3 years old, the male/female ratio was 1.8, the rate of traffic accident was 80.6%. Clinical symptoms included: Abdominal pain 100%, abdominal distension 46.3%, abdominal wall injury 35.8%, and associated injury including: Thoracic trauma 29.9%, extremity trauma 19.4%, maxillofacial trauma 10.4%, brain trauma 1.5%, spinal trauma 1.5%, pelvic trauma 4.5%, spleen 11.9%, kidney and adrenal gland 7.5%. Concentrations of liver enzymes ALT and AST were 421.2 ± 338.4U/l and 466.1 ± 352.8U/l, respectively. Ultrasound detected parenchymal injury at 88.1% and free intra-abdominal fluid at 79.1%. Computed tomography (CT) detected parenchymal injury at 100%, free intra-abdominal fluid at 76.1%, lesions in right hepatic lobe at 95.5%, liver injury grade II-III at 92.5%, morphology contusion-parenchymal hematoma at 83.6%. The average length of hospital stay was 10.1 ± 5.2 days. 18 patients had received 2 to 8 units of red blood cells (250ml per unit) during the treatment period. The complication rate was 3%, in which there was one case of bile leakage and one case of hepatic failure. The overall success rate of non-operative management was 98.5%. Conclusion: Non-operative management of liver rupture due to blunt abdominal trauma is safe and feasible. The complication rate was low, the success rate was high (98.5%) and there was no mortality.