Ji Chunyi,Yin Qiang,Chen Lijian,et al.Characteristics and efficacy analysis of diagnosis and treatment in pediatric abdominal closed liver trauma in a single center[J].Journal of Clinical Pediatric Surgery,,():952-957.[doi:10.3760/cma.j.cn101785-202406016-010]
Characteristics and efficacy analysis of diagnosis and treatment in pediatric abdominal closed liver trauma in a single center
- Keywords:
- Liver Trauma; Surgical Procedures; Operative; Child
- Abstract:
- Objective To summarize the experience in diagnosing and treating pediatric liver trauma and to explore treatment strategies for pediatric abdominal closed liver trauma. Methods A retrospective analysis was conducted on the clinical data of 150 children with liver trauma treated at the Department of General Surgery, Hunan Children’s Hospital, from January 2013 to December 2022.The study included 85 males and 65 females, aged 4.66±2.91 years.Treatment approaches were selected based on indicators such as hemoglobin (HB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), prothrombin time (PT), activated partial thromboplastin time (APTT), the World Society of Emergency Surgery (WSES) liver trauma grading, and the American Association for the Surgery of Trauma (AAST) liver trauma grading.Patients were divided into a conservative treatment group and a surgical treatment group. Observation indicators include HB, ALT, AST, TBIL, PT, APTT, AAST, and WSES grading, length of hospital stay (d), cure rate, and complications. Results Among the 150 cases, 131 were treated conservatively, and 19 underwent surgery (14 cases of liver resection and 5 cases of liver repair surgery).Except for one death due to severe hemorrhagic shock, the remaining 149 cases were successfully treated.In the conservative treatment group, there were significant differences in HB [(106.71±15.41) vs.(116.17±12.76)], AST [(544.12±225.05) vs.(33.11±7.86)], ALT [(513.23±207.58) vs.(43.60±19.00)], and TBIL [(10.42±3.38) vs.(8.24±2.75)] before and after treatment (P<0.05).In the surgical treatment group, there were significant differences in HB [(93.33±15.42) vs.(120.67±14.14)], AST [(547.71±230.83) vs.(30.34±6.21)], ALT [(523.22±240.98) vs.(31.57±15.90)], and TBIL [(10.53±3.65) vs.(7.86±2.28)] before and after treatment (P<0.05).However, there were no significant differences in PT or APTT before and after treatment in either group (P>0.05).Additionally, there were no statistically significant differences between the two groups in terms of these indicators before and after treatment (P>0.05). Conclusions Regardless of the grading standards used (AAST or WSES), the vast majority of children with Ⅰ, Ⅱ, and Ⅲ degree liver trauma, as well as some with AAST-IV liver trauma, can be successfully treated with non-surgical approaches.However, for children with WSES-Ⅳ liver trauma, surgical intervention should be promptly considered if hemodynamic instability occurs, irrespective of AAST grading.
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Memo
收稿日期:2024-6-7。
基金项目:湖南省科技厅自然科学基金项目(2021JJ40268);湖南省科技厅自然科学基金项目(2023JJ30329);国家临床重点专科建设培育项目-湖南省儿童医院小儿普外科
通讯作者:尹强,Email:qiangyin@hotmail.com