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Hepatobiliary Surgery - part 10

Mô tả tổn thương tôi tụ máu dưới bao cấp, nonexpanding, 50% bề mặt hoặc khu vực mở rộng, tụ máu dưới bao bị vỡ với hoạt động xuất huyết, tụ máu intraparenchymal 10 cm hoặc 3 cm chiều sâu mở rộng nhu mô vỡ tụ máu intraparenchymal với sự gián đoạn hoạt động xuất huyết nhu mô | 258 Heptobiliary Surgery Table 19.1. American Association for the Surgery of Trauma Liver Injury Scale 1994 Revision Grade I Hematoma Injury Description Subcapsular nonexpanding 10 cm surface area Laceration Capsular tear nonbleeding 1 cm parenchymal depth II Hematoma Subcapsular nonexpanding 10-50 surface area intraparenchymal nonexpanding 10 cm diameter Laceration Capsular tear active bleeding 1-3 cm parenchymal depth 10 cm length III Hematoma Subcapsular 50 surface area or expanding ruptured subcapsular hematoma with active bleeding intraparenchymal hematoma 10 cm or expanding Laceration 3 cm parenchymal depth IV Hematoma Ruptured intraparenchymal hematoma with active bleeding Laceration Parenchymal disruption involving 25-75 of hepatic lobe or 1-3 Couinaud s segments within a single lobe V Laceration Parenchymal disruption involving 75 of hepatic lobe or 3 Couinaud s segments within a single lobe Vascular Juxtahepatic venous injuries VI Vascular Hepatic avulsion J Trauma 1995 38 323 Diagnosis of Blunt Hepatic Trauma Motor vehicle accidents MVAs account for the majority of blunt hepatic injuries with unrestrained drivers and passengers at greatest risk and pedestrians struck by vehicles falls and assaults accounting for the remaining injuries. Advances in prehospital care such as intubation and fluid resuscitation in the field coupled with rapid transport times have resulted in increasingly critically injured patients reaching the hospital alive. Hemodynamically unstable patients with obvious hemoperitoneum should be quickly resuscitated and immediately transferred to the operating room as further work-up only delays definitive treatment and results in death from exsanguination Fig. 19.1 . 19 Surgical Techniques in the Management of Hepatic Trauma 259 Fig. 19.1. Triage of blunt hepatic trauma in the Emergency Department The hemodynamically stable patient can undergo further diagnostic studies and subspecialty consultation as needed. However the trauma surgeon .