摘要: Hypothesis : Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design : Multicenter historical cohort. Setting :... 展开 Hypothesis : Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design : Multicenter historical cohort. Setting : Seven urban level I trauma centers. Patients : Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention : Nonoperative treatment of complex blunt hepatic injuries. Main Outcome Measures : Complications and treatment strategies. Results : Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1: and bile duct injury, 1) , abdominal compartment syndrome (5), and infections (abscess, 7 ; necrosis, 2; and suspected abdmonial sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; intreventional radiology drainage, 16; paracentesis, 1; lasprotomy, 24; and laparoscopy, 4). Hepactic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. 收起