The Therapeutic Analysis For Traumatic Hepatic Rupture In 62 Cases

Objective: To discuss how to make choices of therapeutic and operative methods to traumatic hepatic rupture. In order to raise the level of surgical therapy for patients with traumatic hepatic rupture. Methods: We retrospective analyzed 62 cases of traumatic hepatic rupture in our hospital admitted from Feb 2002 to Sep 2009. For comparisons, data were expressed as the mean±SD for continuous variables and as a percentage for discrete variables, statistical analyses were performed using the t test for continuous variables and chi-square test for discrete variables. A p value of less than 0.05 was significant. Results: Out of all cases, 59 cases were cured and 3 cases died. cure rate was 95.1% (59/62), mortality was 4.9% (3/62). In non-operative therapy group, 25 cases were all cured, cure rate was 100% (25/25). In emergency operative therapy group, 34 cases were cured and 3 died. 3 cases died of multiple organs dysfunction syndrome (MODS). Different operation were performed as following: suture of laceration in 14 cases, suture and omentum or gelatin sponge packing in 15 cases, debridemental hepatectomy in 6 cases, anatomical hepatectomy in 2 cases. The postoperative complications occurred in 9 cases including 3 cases of MODS, 1 case of postoperative rebleeding, 1 case of biliary fistula, 2 cases of infection of incisional wound, and 2 case of pulmonary infection. The main reasons of death were severe shock and severe traumatic complications. Conclusion: Comprehensive operation can greatly improve the succesful rate and reduce the complications, strictly grasping the indication of conservative treatment can greatly improve the cure rate. It is suitable for non-operative therapy with gradeⅠand for operative therapy with gradeⅣ～Ⅴmainly by resection irregularly; Either non-operative or operative therapy may do according to hemadynamics,quantity of seroperitoneum,peritonitis sign and results of B mode ultrasound or CT with gradeⅡ～Ⅲ. we consider that the debridement plus packing with the colic omentum or gelatin sponge,and debriding hepatectomy are mainly procedures for the treatment of the patients with traumatic hepatic rupture.