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Zur Frage des operativen Vorgehens bei Lebertrauma

Problems in the management of liver trauma

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Summary

In the last ten years 43 patients with blunt liver trauma and 11 with penetrating liver wounds have been treated. The mortality rate after blunt liver trauma was close to 63 %; all penetrating wounds were survived. The prognosis after trauma depended significantly on the number of additional wounds, the extent of blood loss, and the age of the patients. Management of liver trauma was performed in most of the cases (n = 41) by suture and drainage. Packing of the wounds and resection were performed in four cases each. In nine cases, the bleeding did not stop sufficiently after suture, debridement, or packing of the wounds. It is concluded that in those cases hepatic resection or hepatic artery ligation — depending on the extent of trauma — should be done in future.

Zusammenfassung

Es wird über 43 stumpfe sowie 11 penetrierende Leberverletzungen berichtet, die in den letzten 10 Jahren zur stationären Behandlung kamen. Die Letalität der stumpfen Verletzungen lag bei 63%, die penetrierenden Verletzungen wurden alle überlebt. Die Prognose der Verletzungen war von der Anzahl der Zusatzverletzungen, dem Ausmaß des Blutverlustes sowie dem Alter der Patienten signifikant abhängig. Die Versorgung der Verletzungen erfolgte in der überwiegenden Mehrzahl der Fälle (n = 41) durch Lebernaht und Drainage, die Tamponade der Wunde bzw. die Leberresektion wurde in 4 Fällen durchgeführt. Bei 9 Patienten gelang weder mit Lebernaht noch Debridement oder Tamponade eine ausreichende Blutstillung. In solchen Fällen sollte in Zukunft die Leberresektion (bei Verletzung eines Leberlappens) bzw. — bei Verletzung beider Leberlappen — die Ligatur der A. hepatica angewendet werden.

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Authors and Affiliations

  1. Chirurgische Universitätsklinik, Joseph-Stelzmann-Straße 9, D-5000, Köln 41

    R. Grundmann, G. Marqua & H. Pichlmaier

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  1. R. Grundmann
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  2. G. Marqua
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  3. H. Pichlmaier
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Vortrag gehalten auf der 96. Tagung der Deutschen Gesellschaft für Chirurgie

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Grundmann, R., Marqua, G. & Pichlmaier, H. Zur Frage des operativen Vorgehens bei Lebertrauma. Langenbecks Arch Chiv 350, 215–226 (1980). https://doi.org/10.1007/BF01237631

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  • DOI: https://doi.org/10.1007/BF01237631

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