Grade 4 외상성 간 손상에 대한 보존적 치료
Nonoperative Treatment for Grade IV Liver Injury
외상성 간 손상 Grade 4 치료;
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Background: Though nonoperative management of liver injury (NOMLI) was frequently employed for traumatic liver injury, the indication for NOMLI for grade IV liver injury is still controversial. To determine the usefulness of the NOMLI in grade IV liver injury, we compared clinical features of operative management group (n=26) with NOMLI group (n=20). Materials and Methods: 46 cases of grade IV liver injury according to AAST liver injury scale for 10 years till Feb. 2004 were selected in Kyungpook National University Hospital. The clinical features, grade of liver injury, and outcomes of treatments were reviewed retrospectively. Results: Male was 87% (40/46) and female was 13% (6/46). The mean age of male and female were 37.6±15.2 and 34.5±16.7, respectively. The causes of liver trauma were vehicle accident (71.7%, 33/46), industry accident (26.1%, 12/46), and violence (2.2%, 1/46). The accompanying abdominal injury was not present in NOMLI group compared to 30.8% (8/26) in operative management group. NOMLI was more than 2 times frequently indicated after Feb. 1999. Mortality in operative management group was 11.5% (3/26) compared to no mortality in NOMLI group. 20% (4/20) of NOMLI group failed due to delayed bleeding and eventually underwent operations and the 80% (16/20) of NOMLI group was successful. The morbidity in successful NOMLI group was bile collection (6.25%, 1/16) and empyema (6.25%, 1/16). Conclusion: Nonoperative management for grade IV liver injury in hemodynamically stable patients without accompanying abdominal injury was successful. However, continuous monitoring and immediate operative management should be prepared for the delayed bleeding.