Læknablaðið - 15.01.1997, Side 8

8
LÆKNABLAÐIÐ 1997; 83
Aðgerðir við lifraráverka
Yfirlit frá Borgarspítala 1968-1993
Auðun Svavar Sigurðson1’, Jónas Magnússon2’, Gunnar H. Gunnlaugsson3’
Sigurðsson AS, Magnússon J, Gunnlaugsson GH
Opcrations for liver injury 1968-93. A review from
thc Reykjavik City Hospital.
Læknablaðið 1997; 83: 8-15
Objective: The purpose of the study was to disclose
the operative experience with liver injuries at the
Reykjavik City Hospital for the years 1968-1993 and
compare the results to those reported by others.
Material and methods: Journals for all patients un-
dergoing an operation for liver injury during the
period were studied. Age and sex, cause of injury,
condition on arrival at the hospital, additional in-
juries, length of the operation, number of trans-
fusions, hospital stay, indications for surgery, type
of surgery, complications and mortality were all
noted. The abbreviated injury severity scale
(AIS-90) was used to classify the liver injuries. The
injury severity score (ISS) was calculated for each
patient.
Results: There were 41 patients, 28 males and 13
females. The median age was 20 years (5-78) and
one fourth were children under 10 years. Blunt trau-
ma caused 84% of the injuries and traffic accident
the most common cause. Seventeen patients
(42.5%) were in shock (systolic BP under 90) on
arrivai and 12 (29%) were still in shock at the begin-
ning of the operation. Each patient had on the aver-
age 2.22 additional injuries inside or outside the
abdomen. The number of transfusions required,
hospital stay and operative time were extremely var-
iable the median being 1.4 liters, 100 minutes and 15
days respectively. The most common indication for
laparatomy was shock or fluid in the abdomen as
Frá '’Department of thoracic surgery, Birmingham Heart-
lands hospital, Birmingham, 2)handlækningadeild Landspít-
alans, 3,skurðlækningadeild Borgarspítalans. Fyrirspurnir,
bréfaskipti: Gunnar H. Gunnlaugsson, skurðlækningadeild
Sjúkrahúss Reykjavíkur, Fossvogi.
shown by ultrasound and signs of peritoneal irrita-
tion. The liver was bleeding at the time of surgery in
51.3% of cases. Bleeding could in most instances be
controlled with sutures. Three patients underwent a
major hepatic resection and all survived. One of the
three had an associated vena cava injury. There
were 20 major complications of which abdominal
sepsis and renal failure were the most common.
Seven patients died (17%) but only one of liver
bleeding on the operating table. Others died from
brain injury, chest injury or multiple organ failure.
Seventy one per cent had minor or moderate injury
to the liver (class I or II) while 29% had major or
massive injury (class III or VI). Twenty three pa-
tients (56%) had injury severity score (ISS) under
16. One of these 23 patients died, an elderly man
with cirrhosis and incurable carcinoma of the liver.
Other patients who died had ISS of 41 or higher. In
this series are only patients who underwent an oper-
ation. In recent years there has been a growing
tendency to treat liver injury without operation.
From 1988-93 seven of 15 patients with liver injury
were treated without operation.
Conclusions: Most of the results in this study are
similar to those reported by others. The mortality is
low when compared to authors who mostly have
closed injuries in their series as we do. No patient
with normal liver before the accident died unless he
had ISS of 41 or higher. This fact along with the low
mortality seem to indicate that treatment was of
high standard.
Ágrip
Tilgangur: Tilgangur rannsóknarinnar var
að kanna árangur af aðgerðum við lifraráverka
á Borgarspítalanum á árabilinu 1968-1993
einkum með tilliti til dánartíðni og bera hann
saman við niðurstöður rannsókna frá öðrum
löndum.
Aðferð: Sjúkraskrár allra sjúklinga sem
gengust undir skurðaðgerð vegna lifraráverka
á tímabilinu voru kannaðar. Athuguð var ald-