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- 저자 : 조현언(Hyun-Eun Cho) (검색결과 2 건)
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홍순찬,최상경,박순태,하우송,이진석,권수인,이영준,정은정,조현언,정광근,임병찬 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.2
Because of the merit of nonoperative management of blunt hepatic trauma, which is the avoidance of operative morbidity, the use of nonoperative management has been extended. However the indications for such treatment have not been sufficiently determined. To suggest possible criteria for nonoperative management, we reviewed 95 cases with blunt hepatic injuries which were confirmed by abdominal exploration or abdominal CT in Gyeong Sang National University Hospital from January 1992 to October 2000. Of the 95 patients, 38 patients were treated with operation and 57 patients treated with nonoperative management. We analyzed the patients for age, sex, cause of injury, injured organ, injury grade, transfusion amount, and shock on admission, complications and mortality. The results are as follows; 1) The peak incidence of age was in the 3rd decade (20%), and the male-to-female ratio was 3:1. 2) The most frequent injury mechanism was traffic accidents (40, 42%). 3) The most frequently used diagnostic modality was abdominal CT (95 cases) in the nonoperative and the operative group. 4) On the liver injury scale of the American Association for the Surgery of Trauma (AAST), 13 were grade I, 18 were grade II, 10 were grade III, 13 were grade IV, and 3 were grade V in the nonoperative group ; 1 were grade I, 6 were grade II, 18 were grade III, 8 were grade IV, 4 were grade V, and 1 were grade VI in the operative group. 5) Between the nonoperative and the operative groups, there were significant differences in the systolic blood pressure in the first 8 and 24 hours, transfusion amount, and GOT/GPT level (p$lt;0.05). 6) In comparison of complication, there were 3 cases of heaptic abscess,1 case of intrahepatic hematoma, 1 case of bile leakage, 1 case of rebleeding in operative group (15.7%). There were 2 cases of intrahepatic abscess, 2 cases of intrahepatic hematoma, 4 cases of biloma, 1 case of subcapsular hematoma in nonoperative group (15.7%). In mortality cases, 6patients died in operative group. Among them, 5patiens died from DIC (disseminated intravascular coagulation) and multiorgan failure, 1patient died from ARDS (adult respiratory distress syndrome) in operative group and 2patients died from hypovolemic shock in nonoperative group. In conclusion, i) nonoperative management may be considered as a first choice in children and adults with blunt abdominal trauma and stable vital signs. ii) Patients with hemodynamically stable hepatic injury 8 hrs after resuscitation, even with an AAST OIS grade 4 injury, may be candidates for nonoperative management.
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