복부 둔상 후에 발생한 간과 비장 손상의 치료 및 추적 검사
Nonoperative Management and Follow-up of Hepatic and Splenic Injuries after Blunt Trauma
이근호, 홍민광, 오세정, 박승만, 김영하, 손경명,
소속 상세정보
이근호 ( Lee Keun-Ho )
가톨릭대학교 의과대학 성모자애병원 외과학교실
홍민광 ( Hong Min-Kwang )
가톨릭대학교 의과대학 성모자애병원 외과학교실
오세정 ( Oh Se-Jeong )
가톨릭대학교 의과대학 성모자애병원 외과학교실
박승만 ( Park Seung-Man )
가톨릭대학교 의과대학 성모자애병원 외과학교실
김영하 ( Kim Young-Ha )
가톨릭대학교 의과대학 성모자애병원 외과학교실
손경명 ( Sohn Kyung-Myung )
가톨릭대학교 의과대학 성모자애병원 방사선과학교실
KMID : 0371320010600020204
Abstract
Purpose: This study evaluates the effectiveness of nonoperative management of blunt hepatic and splenic injuries and the efficiency of follow-up.
Methods: The medical records of 49 patients with blunt hepatic and splenic injuries from January 1, 1993, to November 30, 1999, were reviewed. There were 35 patients with hepatic injuries and 14 patients with splenic injuries. The patients were divided into two groups, early and late, according to the year of injury. The severities of the injuries were determined by using the organ injury scale (OIS). We analyzed radiological findings and clinical parameters, including the cause of injury, combined injuries, symptoms, vital signs, amount of transfusion, reason for operation, operative findings, length of hospital stay, and complications. The results of treatment and follow-up were evaluated.
Results: Of the 49 patients, 34 patients (69.4%) were treated nonoperatively. There were no mortalities and treatment failures in patients with nonoperative treatment. Indications of operation during nonoperative treatment were hemodynamic instability and signs of aggravated peritoneal irritation. Major hepatic venous injury was suggestive of hemodynamic instability. There was a significant difference between patients with nonoperative management and those with operative management in transfusion requirements (1.2 units vs. 12.1 units, p＜0.05). The rate of nonoperative management increased from 50.0% (12/24) in the early group to 88.0% (22/25) in the late group, and nontherapeutic operation decreased from 16.7% (2/12) in the early group to 0% (0/3) in the late group. All 34 patients with nonoperative mana-gement took CT scans as a follow-up. In patients with grade I or II on the OIS, the lesions had nearly disappeared at 2 weeks after injury. However, in patients with grade III or higher, resolusion of the lesion was minimal. A hepatic cyst developed in one patient with grade IV and a splenic cyst developed in another.
Conclusion: Hemodynamic stability and findings on serial physical examinations are significant criteria for nonoperative management of blunt hepatic and splenic injuries. In patients with grade I or II injuries on the OIS, a follow-up CT is not necessary. In patients with grade III or higher, it is more efficient to delay a follow-up CT until 3 weeks or later after the injury if there are no symptom suggesting complications.
키워드
간 손상;비장 손상;보존적 치료;추적 검사
Liver;Spleen;Trauma;Nonoperative management;Follow-up
원문 및 링크아웃 정보
등재저널 정보