Abstract:

Objective

To investigate the application of full-process management with finger-pinching hepatectomy as the core technology in severe liver trauma involving hepatic vein trunk.

Methods

Clinical data of 18 patients with severe liver trauma involving hepatic vein trunk admitted to the First People's Hospital of Chenzhou from January 2017 to July 2023 were retrospectively analyzed.The informed consents of all patients and/or their family members were obtained and the local ethical committee approval was received.Among them, 10 patients were male and 8 female, aged from 2.5 to 65.0 years, with a median age of 32.5 years.According to the American Association for the Surgery of Trauma (AAST) grading scale, all patients were classified as grade Ⅴ liver trauma.Standardized full-process management was adopted before, during and after surgery.Preoperative preparations were rapidly made.Intraoperatively, liver resection was performed by finger pinching, gauze packing was used to stop bleeding, chief surgeon coordinated with the assistant surgeon to repair and suture the inferior vena cava rupture and hepatic vein trunk rupture using atraumatic sutures.Perioperative status and efficacy of all patients were observed.

Results

16 cases were successfully treated, including 11 cases undergoing once abdominal surgery at one time and the remaining 5 cases were treated with gauze packing according to the theory of damage control surgery and then the gauze was taken out by secondary or multiple surgeries.The treatment success rate reached 89%(16/18).2 cases died.One 8-year-old boy died from intraoperative massive hemorrhage of the inferior vena cava and air embolism.Another 2.5-year-old girl died from excessive blood loss during surgery.The liver resection time was ranged from 5 to 30 min, and the median liver resection time was 20 min.The remaining 16 patients were discharged smoothly.

Conclusions

For patients with severe liver trauma involving hepatic vein trunk,the full-process management with ＂finger-pinching hepatectomy＂ as the core technology can significantly improve the treatment success rate.

Key words: Liver rupture, Hepatectomy, Liver resection with finger pinching, Damage control theory, Hepatic vein